Table 3

Recommendations for management of pregnancy in polycythemia vera

Risk stratification: at least 1 of the following defines high-risk pregnancy 
        Previous major thrombotic or bleeding complication 
        Previous severe pregnancy complications* 
Therapy 
    Low-risk pregnancy 
        Target hematocrit should be kept below 0.45 (45%) 
        Aspirin 100 mg/day 
        LMWH 4000 U/day for the first 6 weeks after delivery 
    High-risk pregnancy 
        As described for low risk, plus: 
        If previous major thrombosis or severe pregnancy complications, LMWH 4000 U/day throughout pregnancy (stop aspirin if bleeding complications). 
        If myelosuppression is required, consider IFN-α 
Risk stratification: at least 1 of the following defines high-risk pregnancy 
        Previous major thrombotic or bleeding complication 
        Previous severe pregnancy complications* 
Therapy 
    Low-risk pregnancy 
        Target hematocrit should be kept below 0.45 (45%) 
        Aspirin 100 mg/day 
        LMWH 4000 U/day for the first 6 weeks after delivery 
    High-risk pregnancy 
        As described for low risk, plus: 
        If previous major thrombosis or severe pregnancy complications, LMWH 4000 U/day throughout pregnancy (stop aspirin if bleeding complications). 
        If myelosuppression is required, consider IFN-α 
*

Severe pregnancy complications: at least 3 first-trimester losses or at least 1 second- or third-trimester loss; birth weight lower than the fifth centile of gestation; preeclampsia; intrauterine death; or stillbirth.

Disease-related prior reason for cytotoxic therapy or uncontrolled hematocrit or progressive myeloproliferation (leukocytosis, thrombocytosis, splenomegaly).

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