Table 3. Leading guidelines for VTE... | American Society of Hematology

Table 3.

Leading guidelines for VTE prevention in pregnancy

History	Presence and risk category of thrombophilia*	Risk period: antepartum (AP) vs postpartum (PP)	ACCP	ACOG	Royal College of Obstetricians and Gynecologists (RCOG)
Prior VTE, provoked by a transient risk factor, unrelated to pregnancy/estrogens	No	AP	−	−	−†
	No	PP	+	+	+
	Yes: Low risk	AP	−	±	+
	Yes: Low risk	PP	+	+	+
	Yes: High risk	AP	−	+	+
	Yes: High risk	PP	+	+	+
Prior VTE in the context of exogenous estrogen, pregnancy, or unprovoked	No	AP	+	+	+
	No	PP	+	+	+
	Yes: Low risk	AP	+	+	+
	Yes: Low risk	PP	+	+	+
	Yes: High risk	AP	+	+	+
	Yes: High risk	PP	+	+	+
No personal history of VTE, positive family history of VTE	No	AP	−	−	−
	No	PP	−	−	−
	Yes: Low risk	AP	−	±	−
	Yes: Low risk	PP	+	±	+
	Yes: High risk	AP	+	±	±
	Yes: High risk	PP	+	+	+
No personal history of VTE, No family history of VTE	No	AP	−	−	−
	No	PP	−	−	−
	Yes: Low risk	AP	−	±	−
	Yes: Low risk	PP	−	±	−‡
	Yes: High risk	AP	−	+	±
	Yes: High risk	PP	+	+	+

History	Presence and risk category of thrombophilia*	Risk period: antepartum (AP) vs postpartum (PP)	ACCP	ACOG	Royal College of Obstetricians and Gynecologists (RCOG)
Prior VTE, provoked by a transient risk factor, unrelated to pregnancy/estrogens	No	AP	−	−	−†
	No	PP	+	+	+
	Yes: Low risk	AP	−	±	+
	Yes: Low risk	PP	+	+	+
	Yes: High risk	AP	−	+	+
	Yes: High risk	PP	+	+	+
Prior VTE in the context of exogenous estrogen, pregnancy, or unprovoked	No	AP	+	+	+
	No	PP	+	+	+
	Yes: Low risk	AP	+	+	+
	Yes: Low risk	PP	+	+	+
	Yes: High risk	AP	+	+	+
	Yes: High risk	PP	+	+	+
No personal history of VTE, positive family history of VTE	No	AP	−	−	−
	No	PP	−	−	−
	Yes: Low risk	AP	−	±	−
	Yes: Low risk	PP	+	±	+
	Yes: High risk	AP	+	±	±
	Yes: High risk	PP	+	+	+
No personal history of VTE, No family history of VTE	No	AP	−	−	−
	No	PP	−	−	−
	Yes: Low risk	AP	−	±	−
	Yes: Low risk	PP	−	±	−‡
	Yes: High risk	AP	−	+	±
	Yes: High risk	PP	+	+	+

“+” and “−” indicate recommendations for or against use of thromboprophylaxis, respectively

Guidelines definitions of low- vs high-risk thrombophilias differ: factor V Leiden and prothrombin gene heterozygosity are considered low-risk thrombophilias by all 3 organizations. Homozygosity or compound heterozygosity for factor V Leiden and/or prothrombin gene mutation are considered high risk by all 3 organizations. Protein C and S deficiency are considered high risk only by RCOG (ie, considered low risk by ACCP and ACOG), and antithrombin deficiency is considered high risk only by ACOG and RCOG (ie, considered low risk by ACCP).

†

Thromboprophylaxis recommended at 28 weeks.

‡

May consider thromboprophylaxis based on the presence and number of other VTE risk factors.

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