Society of Family Planning clinical recommendations: Management of individuals with bleeding or thrombotic disorders undergoing abortion

Abstract

Individuals who have bleeding disorders, thrombophilias, a history of venous thromboembolism (VTE), or who are taking anticoagulation medication for other reasons may present for abortion. Clinicians should be aware of risk factors and histories concerning for excessive bleeding and thrombotic disorders around the time of abortion. This document will focus on how to approach abortion planning in these individuals . For first-trimester abortion, procedural abortion (sometimes called surgical abortion) is generally preferred over medical management for individuals with bleeding disorders or who are on anticoagulation. First-trimester procedural abortion in an individual on anticoagulation can generally be done without interruption of anticoagulation. The decision to interrupt anticoagulation for a second-trimester procedure should be individualized. Individuals at high risk for VTE can be offered anticoagulation post-procedure. Individuals with bleeding disorders or who are anticoagulated can safely be offered progestin intrauterine devices. Future research is needed to better assess quantitative blood loss and complications rates with abortion in these populations.

Induced Abortion for Maternal Cardiac Indication

“…Contraindications to medication abortion such as severe anemia and anticoagulation may present an additional challenge. 10 For patients undergoing surgical abortion, anticoagulation should weigh individualized bleeding and thrombotic risks. Anticoagulation can be safely continued peri-procedurally in the first trimester for patients without additional risk factors for bleeding.…”

Second-trimester abortion care for those with complex medical conditions

“…Antepartum initiation of anticoagulation is recommended for those with a personal history of unprovoked or hormonally provoked venous thromboembolism (VTE), low-risk thrombophilia and a family history of VTE, or high-risk thrombophilia regardless of family history [28]. SFP recommend initiating anticoagulation on these individuals found to be incidentally pregnant undergoing abortion [27]. As there is no existing evidence regarding how long an increased risk of VTE persists after abortion, SFP suggest considering continuing anticoagulation 4-6 weeks postabortion [27].…”

“…SFP recommend initiating anticoagulation on these individuals found to be incidentally pregnant undergoing abortion [27]. As there is no existing evidence regarding how long an increased risk of VTE persists after abortion, SFP suggest considering continuing anticoagulation 4-6 weeks postabortion [27].…”

“…Although SFP do not recommend interrupting anticoagulation for a first-trimester procedure given nonclinically significant increases in blood loss associated with these procedures [27,29,30], the decision for continuation, interruption, or modification of anticoagulation should be individualized for those in the second trimester. Clinicians, in consultation with Hematology, should weigh the risk of thromboembolism in the peri-abortion period with the risk of hemorrhage.…”

“…Platelets should be trended before and immediately after D&E given the relatively high rate of clinically significant thrombocytopenia associated with this disease process [25 ▪ ]. As the American College of Obstetrics and Gynecology (ACOG) recommend platelet transfusion to increase maternal platelet count to >50 000 per cubic millimeter before major abdominal surgery including cesarean birth [26], SFP have similarly endorsed this transfusion threshold for abortion care [27].…”