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”
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