Prevention of postpartum venous thromboembolism (VTE)

Abstract

Venous thromboembolism (VTE) is a leading cause of maternal mortality in developed countries. The baseline pregnancy-associated VTE (PA-VTE) risk is further increased by additional maternal, pregnancy, and delivery characteristics. In a recently developed risk prediction model for postpartum VTE, emergency caesarean section, stillbirth, postpartum haemorrhage, pre-eclampsia/eclampsia, infection, and medical comorbidities were the strongest VTE predictors. While the evidence base supporting optimal strategies for reducing the risk of postpartum VTE in general is weak, for women with prior VTE it appears that this risk may be reduced by up to 75% with low-molecular-weight heparin (LMWH). VTE prevention in women with more common VTE risk factors is a knowledge gap in 2020, with widely varying international guideline recommendations. However, there is no debate surrounding the requirement to perform systematic VTE risk assessment in pregnant and postpartum women.