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Sep 6, 2025, 14:04

Chokri Ben Lamine – VTE Prophylaxis in Pregnancy (ASH 2018 Guidelines)

Dr. Chokri Ben Lamine, Adult Hematology and Stem Cell Transplantation Assistant Consultant at Oncology Center of Excellence at King Faisal Specialist Hospital and Research Center, shared an insightful post on X:

“ASH 2018 VTE Prophylaxis in Pregnancy

Prior VTE

Unprovoked / hormone-related → Antepartum: Yes, Postpartum: Yes
Provoked (transient risk only) → Antepartum: No, Postpartum: Yes

Thrombophilia
Heterozygous FVL / Prothrombin G20210A

No FHx → Antepartum: No, Postpartum: No
+FHx → Antepartum: No, Postpartum: Yes

Protein C deficiency

No FHx → Antepartum: No, Postpartum: No
+FHx → Antepartum: No, Postpartum: Yes

Protein S deficiency

No FHx → Antepartum: No, Postpartum: No
+FHx → Antepartum: No, Postpartum: Yes

Compound heterozygosity

No FHx → Antepartum: No, Postpartum: Yes
+FHx → Antepartum: Yes, Postpartum: Yes

Homozygous FVL

No FHx → Antepartum: No, Postpartum: Yes
+FHx → Antepartum: Yes, Postpartum: Yes

Homozgous Prothrombin

No FHx → Antepartum: No, Postpartum: No
+FHx → Panel unable to recommend, Postpartum: Yes

Antithrombin deficiency

No FHx → Antepartum: No, Postpartum: No
+FHx → Antepartum: No, Postpartum: Yes

Other risks

No or 1 risk factor → Antepartum: No, Postpartum: Yes
Assisted reproduction →

-Without ovarian hyperstimulation / high-risk → Antepartum: No

-With OHSS or high-risk thrombophilia → Antepartum: Yes, Postpartum: Yes

Pearls for exams

Postpartum period = highest risk → most recommendations support prophylaxis here
Antepartum prophylaxis reserved for high-risk thrombophilia with FHx or prior unprovoked/hormonal VTE
LMWH = preferred agent

Reference: ASH-SAP 9th Ed, Table 3-2”

Chokri Ben Lamine – VTE Prophylaxis in Pregnancy (ASH 2018 Guidelines)