For anticoagulation medications, use the following guidelines:
Antepartum: Use LMWH from first trimester to 36 weeks; then at 36 weeks
transition to UFH until delivery.
Intrapartum
Postpartum
levels
Disadvantages: cannot use orally, higher cost, can not be reversed
Warfarin (Coumadin) can be used only postpartum.
Advantages: oral administration, long half-life, inexpensive, OK for
breast feeding
Disadvantages: crosses placenta, needs monitoring with INR
None or prophylactic dose
Low-risk thrombophilia without VTE episode
Prophylactic or intermediate-dose
Low-risk thrombophilia with single VTE episode
High-risk thrombophilia without VTE episode
Therapeutic dose
High-risk thrombophilia with single VTE episode
Any thrombophilia with VTE in current pregnancy
Discontinue UFH during immediate peripartum interval to decrease risk of
hemorrhage and permit regional anesthesia.
Protamine sulfate can be used to reverse UFH effect.
VTE risk increased 20-fold in the first week postpartum.