Thromboprophylaxis in pregnancy, delivery and puerperium: a review of literature and current guidelines

Abstract

Introduction. Venous thromboembolism is one of the leading causes of maternal morbidity and mortality. Pregnancy induces a hypercoagulable state as an adaptive mechanism to prevent hemorrhage during childbirth. These physiological changes significantly increase the risk of venous thromboembolism – by up to six-fold during pregnancy and up to 10-fold during the postpartum period compared to the non-pregnant population. Given these risks, proper identification of patients who may benefit from thromboprophylaxis is essential to improve maternal outcomes. Material and methods. This manuscript reviews medical articles and current clinical guidelines on thromboprophylaxis in pregnancy and the puerperium, highlighting similarities, differences, and practical considerations in the management of at-risk patients. International guidelines developed to aid clinicians in venous thromboembolism risk stratification and prevention, including the Royal College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists, the American Society of Hematology, and the National Institute for Health and Care Excellence were analyzed. Results. The incidence of Venous thromboembolism ranges from 1 to 2 per 1,000, with up to 80% attributed to deep vein thrombosis cases occurring during the antepartum period, and 20%-25% being pulmonary embolism cases. In contrast, the incidence of pulmonary embolism is significantly higher after childbirth, with 40% to 60% of all pulmonary embolism cases occurring during the postpartum period. The impact of venous thromboembolism is not limited to mortality. Acute venous thromboembolism and the need for long-term anticoagulant therapy are associated with a significant clinical and psychological burden, while potential long-term sequelae, such as pulmonary hypertension and post-thrombotic syndrome, can have lifelong consequences. Ensuring thromboprophylaxis is essential, and the primary responsibility lies with the obstetrician. Ultimately, effective thromboprophylaxis is about balancing efficacy and safety between the need to prevent a potentially life-threatening event and the cost of an increased risk of bleeding. Conclusions. Effective thromboprophylaxis during pregnancy and the puerperium remains a critical component of maternal care. The national protocol aims to assist healthcare professionals in identifying women at increased risk of venous thromboembolism during pregnancy, childbirth, and the postpartum period, and in making evidence-based decisions regarding the use of thromboprophylaxis and anticoagulant agents.