Anticipated common antepartum management strategies based on intention, used in the “PREP and GO” (PRospective Evaluation of Peripartum Anticoagulation manaGement for thromboembolism; NCT05756244) multicenter prospective cohort study
| Prophylactic-dose LMWH strategies . | More-than-prophylactic-dose (intermediate/therapeutic dose) LMWH strategies . |
|---|---|
| Prophylactic-dose LMWH with expectant management (held with contractions) | More-than-prophylactic-dose LMWH with expectant management (held with contractions) |
| Prophylactic-dose LMWH and IOL (held for 12 hours) | More-than-prophylactic-dose LMWH and IOL (held for 24 hours) |
| Prophylactic-dose LMWH and cesarean delivery (held for 12 hours) | More-than-prophylactic-dose LMWH and caesarean delivery (held for 24 hours) |
| Switched to prophylactic-dose UFHa | Switched to intermediate/therapeutic-dose UFH |
| Prophylactic-dose LMWH strategies . | More-than-prophylactic-dose (intermediate/therapeutic dose) LMWH strategies . |
|---|---|
| Prophylactic-dose LMWH with expectant management (held with contractions) | More-than-prophylactic-dose LMWH with expectant management (held with contractions) |
| Prophylactic-dose LMWH and IOL (held for 12 hours) | More-than-prophylactic-dose LMWH and IOL (held for 24 hours) |
| Prophylactic-dose LMWH and cesarean delivery (held for 12 hours) | More-than-prophylactic-dose LMWH and caesarean delivery (held for 24 hours) |
| Switched to prophylactic-dose UFHa | Switched to intermediate/therapeutic-dose UFH |
Typically switched between 37-38 weeks' gestation.
The primary objective is to estimate the combined incidence of major and clinically relevant nonmajor bleeding up to 6 weeks postpartum for the most common 6 antepartum strategies. Of the 8 strategies listed above, the investigators expect 6 predominant strategies. If other possible strategies are used other than those listed above (eg, continuing anticoagulation throughout labor intentionally or stopping anticoagulation early at 37-38 weeks' gestation), they will also be recorded. Prophylactic-dose LMWH: enoxaparin 40 mg daily, dalteparin 5000 IU daily, tinzaparin 4500 IU daily, nadroparin 2850 IU daily; more-than-prophylactic-dose LMWH: Anything higher in dose than what is listed above, including intermediate-dose and therapeutic-dose LMWH.
IOL, induction of labor; UFH, unfractionated heparin.