Therapeutic anticoagulation during the postnatal peripartum period: a survey of clinical practice

Abstract

BackgroundTherapeutic anticoagulation may be required during pregnancy to treat venous thromboembolism (VTE), for patients considered at high risk of thrombosis and for the management of mechanical heart valves (MHVs). Prescribing of therapeutic anticoagulation during the postnatal peripartum period is complicated by managing the risk of postpartum haemorrhage. Currently, there are no standardised protocols for the use of therapeutic heparin in this setting and no randomised control trials have been undertaken to evaluate best practice.AimUsing survey techniques, this study aimed to establish current practice in Australia and New Zealand regarding the use of therapeutic anticoagulation during the postnatal peripartum period.MethodsThe survey consisted of 36 questions and was made available using the electronic Internet platform Survey Monkey.ResultsFor patients at low risk of rethrombosis, 91% and 78% of respondents would use low molecular weight heparin (LMWH) after standard vaginal delivery (SVD) and after caesarean section (CS), respectively, with the remaining respondents choosing to use unfractionated heparin (UFH). For patients at high risk of rethrombosis, 56% and 51% of respondents would use LMWH after SVD and CS, respectively, with the remaining respondents choosing to use UFH. For patients with MHVs, 29% and 26% of respondents would use LMWH after SVD and CS, respectively, with the remaining respondents choosing to use UFH.ConclusionAlthough this study included a relatively small cohort of respondents, the results do indicate trends among therapeutic anticoagulation in the postnatal peripartum period. Research regarding the most efficacious anticoagulation management would help clinicians develop evidence‐based protocols to guide best practice.