The Use of a Scoring System to Guide Thromboprophylaxis in a High-Risk Pregnant Population

Table 1

Anticoagulation recommendations published in the BJOG, August 1999 [21].

Very high risk
Previous VTE while taking anticoagulants	Thromboprophylaxis with dose adjusted for anti-Xa activity throughout pregnancy and for 12 weeks postpartum.
VTE in the current pregnancy
Antithrombin deficiency
High risk
Previous VTE while not on anticoagulants	Fixed dose of LMWH from 24 weeks, earlier if additional risk factors for VTE. With previous pregnancy associated VTE, start 4–6 weeks ahead of gestation of the previous event and continue for 12 weeks postpartum.
Protein C deficiency and FMH
Homozygous Factor V Leiden
Homozygous prothrombin gene mutation
Combined thrombophilias
Moderate risk
Heterozygous factor V Leiden	Postpartum LMWH prophylaxis for 6 weeks.
Heterozygous prothrombin gene mutation
Heterozygous protein S deficiency
FMH alone
Relatively low risk
Heterozygous Factor V Leiden with no FMH	Monitor for additional risks.
Heterozygous PT gene mutation with no FMH

VTE: venous thromboembolism, LMWH: low molecular weight heparin, FMH: family history of VTE.