Question | Expert opinion | Guideline recommendations |
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Which subpopulation(s) of pregnant women, ante- or post-partum, or those with recurrent pregnancy loss, should be treated with LMWHs such as enoxaparin? | • Women with recurrent pregnancy loss • No evidence to support use of LMWH to prevent recurrent pregnancy loss • Women with antiphospholipid syndrome or with heterozygosity of factor V Leiden mutation • Those undergoing IVF • Those with previous unprovoked or provoked VTE • LMWH is recommended in the case of a severe event such as placenta abruption, intrauterine foetus death or VTE | • ACCP/CHEST [28]: For women requiring long-term VKA treatment who are attempting pregnancy, a switch to LMWH is recommended. In women with no VTE risk factors, prophylaxis is not recommended following a caesarean section. No routine prophylaxis for patients following assisted reproduction • ASH [14]: Prophylaxis is only advised for women undergoing assisted reproductive therapy with severe ovarian hyperstimulation syndrome. For women with previous unprovoked or provoked VTE, ante-partum prophylaxis is advised. For women with antithrombin deficiency who are homozygous for the factor V Leiden regardless of family history, ante-partum and post-partum prophylaxis is recommended. In those with protein S or C deficiency, post-partum prophylaxis is advised • Italian Society of Thrombosis and Haemostasis [29]: Ante- and post-partum prophylaxis is recommended for women with thrombophilic defects. LMWH is recommended in women with prior VTE. Ante- and post-partum LMWH prophylaxis is suggested for women with prior obstetric complications and one thrombophilic defect • RCOG [13]: LMWH is the preferred anticoagulant to treat acute VTE and for antenatal and post-natal prophylaxis. 10 days prophylaxis with LMWH is recommended after an emergency caesarean section and after a planned caesarean section if there are additional risk factors |