Management of Peripartum Anticoagulation in Women with Venous Thromboembolism: An International Survey of Clinical Practice

C. Simard¹, I. Malhamé², E. Rey³, M.P. Carson⁴, V. Tagalakis⁵

¹McGill University, Faculty of Medicine, Montreal, Canada, ²McGill University, McGill University Healthcare Center, Division of General Internal Medicine, Department of Medicine, Research Institute of the McGill University Health Center, Montreal, Canada, ³Université de Montreal, Departments of Medicine and Obstetrics and Gynaecology, Montreal, Canada, ⁴Jersey Shore University Medical Center and Seton Hall Hackensack-Meridian School of Medicine, Nutley, United States, ⁵McGill University, Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Division of General Internal Medicine, Department of Medicine, Montreal, Canada

Abstract Number: LPB0047

Meeting: ISTH 2021 Congress

Theme: Women Health » Pregnancy and Pregnancy Complications

Background: Pregnancy associated venous thromboembolism (VTE) is an important cause of maternal morbidity and mortality. In most cases, treatment consists of weight adjusted low-molecular-weight-heparin (WA LMWH). While guidelines exist regarding the antepartum management of VTE, guidance is lacking with regards to the management of anticoagulation at the time of delivery.

Aims: To describe physician practices in the peripartum management of anticoagulation in women with VTE.

Methods: An electronic survey, active between September 15^th and December 15^th, 2020, was created and validated by content experts. The target sample was members of organizations including the Canadian Venous Thromboembolism and Outcomes Research Network (CanVECTOR), Thrombosis Canada, the North American Society of Obstetric Medicine (NASOM), the International Society of Obstetric Medicine (ISOM), and the Canadian Society of Internal Medicine (CSIM). Descriptive analyses were performed.

Results: Survey respondents were General Internists (54/96, 56.3%), Hematologists (21/96, 21.9%), Obstetricians (6/96, 6.3%) and other specialists (15/96, 15.6%). For the management of a VTE in the first trimester, physicians opted to: continue WA LMWH until planned induction and omit the dose the day prior (46/96, 47.9%), switch to twice daily WA LMWH dosing at 36 weeks and omit the dose the evening prior 42/96, 43.8%), continue once daily WA LMWH and bridge with intravenous heparin (4/96, 4.2%) or had other management strategies (4/96, 4.2%). In the management of a VTE in the third trimester, physicians opted to: continue once daily WA LMWH and omit one dose prior to planned induction (29/96, 30.2%), switch to twice daily dosing at 36 weeks (37/96, 38.5%) or bridge with intravenous heparin (30/96, 31.3%).

Conclusions: The survey highlights a wide variability of practice in the management of peripartum anticoagulation. Larger scale studies are needed to evaluate bleeding and thrombotic risks associated with different anticoagulation strategies at the time of delivery.

To cite this abstract in AMA style:

Simard C, Malhamé I, Rey E, Carson MP, Tagalakis V. Management of Peripartum Anticoagulation in Women with Venous Thromboembolism: An International Survey of Clinical Practice [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/management-of-peripartum-anticoagulation-in-women-with-venous-thromboembolism-an-international-survey-of-clinical-practice/. Accessed November 29, 2021.

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