“Inpatient pharmacological thromboprophylaxis in the antepartum period: an argument for universal thromboprophylaxis”

Venous thromboembolism (VTE), a largely preventable condition, accounts for almost 15% of maternal mortalities. The physiologic changes of pregnancy, including quantitative changes in coagulation factors and compression of vasculature by the gravid uterus, cause an increase in risk of VTE, including deep vein thromboembolism (DVT), pulmonary embolism, and stroke (CVA). Long term antepartum admission for preeclampsia, preterm prelabor rupture of membranes (PPROM) or other high-risk pregnancy needs present additional risk factors for VTE due to the patient's medical condition and their inpatient status. Given the near-universal support for anticoagulation in patients with a history of venous thromboembolism or high-risk thrombophilia, we will focus this work on patients generally considered low or moderate risk. As outpatients, we do not recommend anticoagulation for this lower risk population. However, with the increase in risk factors for VTE with prolonged admission, it is our general practice to discuss the risks, benefits, and alternatives of chemical VTE prophylaxis 72 hours after admission and recommend administration to all patients unless they have active vaginal bleeding or are at risk for imminent delivery. Here, we will argue why this strategy of universal VTE prophylaxis during antepartum admission with unfractionated heparin (UFH) or low-molecular weight heparin (LMWH) is ultimately in the best interest of patient safety.