Table 3 Methods of identifying optimal anticoagulant dose in thrombophilic pregnant women and those with pregnancy loss
Question | Expert opinion | Guideline recommendations |
|---|---|---|
What method do you use to identify optimal dose of anticoagulants in thrombophilic pregnant women and those with pregnancy loss, e.g., PK/PD modelling or other methods? | • Anti-Xa monitoring • Factor Xa activity in prophylaxis is not measured • Routine monitoring of the dose is not recommended, the clinical picture of each patients is more important • PK/PD data is not usually used • The PK/PD profile is required • LMWH dose adjusted to weight • Fixed dose • Full-dose enoxaparin for high-risk patients | • ACCP/CHEST [28]: Anti-Xa measuring is not advised. Intermediate-dose LMWH dose is recommended in pregnant women with a history of VTE, with thrombophilia or with a risk of pregnancy loss • ASH [14]: Routine anti-Xa monitoring to guide dosing is not advised • Italian Society of Thrombosis and Haemostasis [29]: Monitoring platelet count during prophylaxis with LMWH is advised. No evidence to suggest use of anti-Xa monitoring to adjust LMWH dose • RCOG [13]: Titration of LMWH dose against the woman’s booking or early pregnancy weight is advised. Routine measurement of anti-Xa is not recommended except in women < 50 kg or > 90 kg |