Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
بسم الله الرحمن الرحيم
12th Annual  Congress  “RAS EL BAR ”  5- 2009 Thromboprophylaxis During Pregnancy, Birth and Puerperium  Dr. Mahdy El-Mazz...
problem solving
Case 1 <ul><li>A 29-year-old gravida 3, para 1 </li></ul><ul><li>At 7 weeks' gestational age </li></ul><ul><li>History of ...
Which of the following  should be done? <ul><li>A. Factor V Leiden mutation, Protein C and protein S deficiency </li></ul>...
What is the evidence? <ul><li>Women with previous VTE   </li></ul><ul><li>should receive thromboprophylaxis with LMWH ante...
<ul><li>Which women with prior VTE require a thrombophilia screen?   </li></ul>
<ul><li>Women with previous provoked and non estrogen related VTE.  </li></ul><ul><li>Grade C   </li></ul><ul><li>Women wi...
Antenatal Assessment & Management     (To be assessed at booking and repeated if admitted) <ul><li>Single previous VTE +  ...
Antenatal Assessment & Management     (To be assessed at booking and repeated if admitted) 1.Age > 35 yrs 2.Obesity (BMI>3...
Timing of initiation of thromboprophylaxis
Timing of initiation of thromboprophylaxis  <ul><li>first trimester is associated with the greatest risk of VTE, many ante...
Which agents should be used for thromboprophylaxis?
Which agents should be used for thromboprophylaxis?   <ul><li>LMWHs are the agents of choice for antenatal thromboprophyla...
<ul><li>FDA warns docs to stop using Baxter's heparin </li></ul><ul><li>Hundreds of allergic reactions to the blood thinne...
RCOG Guideline April 2009 Thromboprophylaxis During Pregnancy Tinzaparin 20,000U/ml Enoxaparin  (100 U/mg) weight 3500 U/d...
Thromboprophylaxis after delivery
Postnatal Assessment & Management   (to be assessed on Delivery Suite) <ul><li>Any previous VTE </li></ul><ul><li>Asymptom...
Postnatal Assessment & Management   (to be assessed on Delivery Suite) 1.Age > 35 yrs  2.Obesity (BMI>30kg/m2)  3.Parity 3...
Thromboprophylaxis after delivery  <ul><li>The first thromboprophylactic dose of LMWH should be given as soon as possible ...
7 D Thromboprophylaxis with CS  <ul><li>1-Eemergency CS </li></ul><ul><li>2-Elective CS + one or more additional risk </li...
When should thromboprophylaxis be interrupted for delivery?
Delivery  by elective caesarean section in women receiving antenatal LMWH <ul><li>On the day prior to delivery ,the woman ...
<ul><li>Regional techniques should not be used until:- </li></ul><ul><ul><li>12 hours after the previous prophylactic dose...
Thank you
Upcoming SlideShare
Loading in …5
×

of

Thromboprophylaxis Slide 1 Thromboprophylaxis Slide 2 Thromboprophylaxis Slide 3 Thromboprophylaxis Slide 4 Thromboprophylaxis Slide 5 Thromboprophylaxis Slide 6 Thromboprophylaxis Slide 7 Thromboprophylaxis Slide 8 Thromboprophylaxis Slide 9 Thromboprophylaxis Slide 10 Thromboprophylaxis Slide 11 Thromboprophylaxis Slide 12 Thromboprophylaxis Slide 13 Thromboprophylaxis Slide 14 Thromboprophylaxis Slide 15 Thromboprophylaxis Slide 16 Thromboprophylaxis Slide 17 Thromboprophylaxis Slide 18 Thromboprophylaxis Slide 19 Thromboprophylaxis Slide 20 Thromboprophylaxis Slide 21 Thromboprophylaxis Slide 22 Thromboprophylaxis Slide 23 Thromboprophylaxis Slide 24 Thromboprophylaxis Slide 25
Upcoming SlideShare
9. thromboprophylaxis
Next
Download to read offline and view in fullscreen.

9 Likes

Share

Download to read offline

Thromboprophylaxis

Download to read offline

Related Books

Free with a 30 day trial from Scribd

See all

Related Audiobooks

Free with a 30 day trial from Scribd

See all

Thromboprophylaxis

  1. 1. بسم الله الرحمن الرحيم
  2. 2. 12th Annual Congress “RAS EL BAR ” 5- 2009 Thromboprophylaxis During Pregnancy, Birth and Puerperium Dr. Mahdy El-Mazzahy Damietta General Hospital
  3. 3. problem solving
  4. 4. Case 1 <ul><li>A 29-year-old gravida 3, para 1 </li></ul><ul><li>At 7 weeks' gestational age </li></ul><ul><li>History of L.DVT while taking COC pills </li></ul><ul><li>History of 2 miscarriages at 7&9 weeks </li></ul><ul><li>Tall 162cm weight 71 kg : BMI < 27 kg/m2) </li></ul>
  5. 5. Which of the following should be done? <ul><li>A. Factor V Leiden mutation, Protein C and protein S deficiency </li></ul><ul><li>B. Antithrombin deficiency </li></ul><ul><li>C. Lupus anticoagulant /anticardiolipin </li></ul><ul><li>D. All of the above </li></ul><ul><li>E. None of the above </li></ul>E
  6. 6. What is the evidence? <ul><li>Women with previous VTE </li></ul><ul><li>should receive thromboprophylaxis with LMWH antenatally and for 6 weeks post partum if : </li></ul><ul><li>Recurrent VTE </li></ul><ul><li>Unprovoked </li></ul><ul><li>Estrogen/pregnancy related </li></ul><ul><li>With history of VTE in a first degree relative </li></ul><ul><li>With other risk factors </li></ul>RCOG Guideline April 2009 Grade C
  7. 7. <ul><li>Which women with prior VTE require a thrombophilia screen? </li></ul>
  8. 8. <ul><li>Women with previous provoked and non estrogen related VTE. </li></ul><ul><li>Grade C </li></ul><ul><li>Women with a previous single provoked VTE (and no other risk factors) require close surveillance antenatally and prophylaxis with LMWH for 6 weeks post partum. </li></ul><ul><li>Grade C </li></ul>Green-top Guideline April 2009
  9. 9. Antenatal Assessment & Management (To be assessed at booking and repeated if admitted) <ul><li>Single previous VTE + </li></ul><ul><li>*Thrombophilia, or FH </li></ul><ul><li>*Unprovoked/estrogen related </li></ul><ul><li>2. Previous recurrent VTE (>1) </li></ul>HIGH RISK REQUIRES ANTENATAL prophylaxis with LMWH <ul><li>Single previous </li></ul><ul><li>provoked VTE without </li></ul><ul><li>FH or thrombophilia </li></ul><ul><li>Thrombophilia + no VTE </li></ul>Intermediate Risk require close surveillance antenatally and prophylaxis with LMWH for 6 W post partum Green-top Guideline April 2009
  10. 10. Antenatal Assessment & Management (To be assessed at booking and repeated if admitted) 1.Age > 35 yrs 2.Obesity (BMI>30kg/m2) 3.Parity > 3 4 Smoker 5.MEDICAL CO-MORBIDITIES e.g. heart or lung disease; SLE; cancer; inflammatory conditions; Proteinuria >3g/24 hrs; Sickle Cell Disease . 6.Gross varicose veins 7.Current systemic infection 8.Immobility, e.g. paraplegia, SPD, long-haul travel 9.Pre-eclampsia 10. Dehydration/hyperemesis/OHSS 11.Multiple pregnancy or ART 12.Surgical procedure e.g. ERPC 3 or more risk factors 2 or more if admitted <3 risk factors Intermediate Risk Consider antenatal prophylaxis with LMWH Low Risk Mobilisation & avoidance of dehydration. Green-top Guideline April 2009
  11. 11. Timing of initiation of thromboprophylaxis
  12. 12. Timing of initiation of thromboprophylaxis <ul><li>first trimester is associated with the greatest risk of VTE, many antenatal VTE events (including fatal events) occur in the first trimester </li></ul><ul><li>So women should be advised to start LMWH as soon as they have a positive pregnancy test. </li></ul>Green-top Guideline April 2009
  13. 13. Which agents should be used for thromboprophylaxis?
  14. 14. Which agents should be used for thromboprophylaxis? <ul><li>LMWHs are the agents of choice for antenatal thromboprophylaxis. They are as effective and safer than unfractionated heparin. </li></ul><ul><li>Grade A </li></ul>Green-top Guideline April 2009
  15. 15. <ul><li>FDA warns docs to stop using Baxter's heparin </li></ul><ul><li>Hundreds of allergic reactions to the blood thinner have been reported </li></ul>
  16. 16. RCOG Guideline April 2009 Thromboprophylaxis During Pregnancy Tinzaparin 20,000U/ml Enoxaparin (100 U/mg) weight 3500 U/d 4500 U/d 7000 U/d* 9000 u/d* 75u/kg/d* 4500U/12 h 175U/kg/12h (antenatal &postnatal) 20 mg/d 40 mg/d 60 mg/d* 80mg/d* 0.5mg/kg/d* 40 mg/12h 1mg/kg/12h (antenatal) 1.5 mg post Body weight < 50 kg Normal weight : 50–90 kg Body weight 91-130 kg Body weight 131-170 kg >170 kg Higher prophylactic dose(50-90kg) Treatment dose
  17. 17. Thromboprophylaxis after delivery
  18. 18. Postnatal Assessment & Management (to be assessed on Delivery Suite) <ul><li>Any previous VTE </li></ul><ul><li>Asymptomatic Thrombophilia </li></ul>High Risk At least 6 weeks postnatal prophylactic LMWH Caesarean Section in Labour BMI > 40 kg/m2 Prolonged Hospital Admission Intermediate Risk At least 7days postnatal prophylactic LMWH Green-top Guideline April 2009
  19. 19. Postnatal Assessment & Management (to be assessed on Delivery Suite) 1.Age > 35 yrs 2.Obesity (BMI>30kg/m2) 3.Parity 3 4.Smoker 5. Elective Caesarean Section 6.MEDICAL CO-MORBIDITIES e.g. heart or lung disease; SLE; cancer; inflammatory conditions; Proteinuria >3g/24 hrs; Sickle Cell Disease; IVDU 7.Gross varicose veins 8. Current systemic infection 9. Immobility, e.g. paraplegia, SPD, long-haul travel 10 Pre-eclampsia 11.mid-cavity or rotational forceps 12.Prolonged labour (>24 hrs) 13.PPH > 1litre or Blood Transfusion 2 or more risk factors <2 risk factors Intermediate Risk At least 7 days postnatal prophylactic LMWH Low Risk EARLY Mobilisation and avoidance of dehydration. NB If persisting or > 3 risk factors consider extending prophylaxis with LMWH Green-top Guideline April 2009
  20. 20. Thromboprophylaxis after delivery <ul><li>The first thromboprophylactic dose of LMWH should be given as soon as possible after delivery provided there is no post partum haemorrhage . </li></ul>
  21. 21. 7 D Thromboprophylaxis with CS <ul><li>1-Eemergency CS </li></ul><ul><li>2-Elective CS + one or more additional risk </li></ul>Green-top Guideline April 2009
  22. 22. When should thromboprophylaxis be interrupted for delivery?
  23. 23. Delivery by elective caesarean section in women receiving antenatal LMWH <ul><li>On the day prior to delivery ,the woman should receive a thromboprophylactic dose of LMWH </li></ul><ul><li>On the day of delivery, any morning dose should be omitted. </li></ul><ul><li>The thromboprophylactic dose of LMWH heparin should be given by four hours post-operatively or four hours after removal of the epidural catheter. </li></ul>Green-top Guideline April 2009
  24. 24. <ul><li>Regional techniques should not be used until:- </li></ul><ul><ul><li>12 hours after the previous prophylactic dose of LMWH and </li></ul></ul><ul><ul><li>24 hours after the last therapeutic dose.. </li></ul></ul><ul><li>cannula should not be removed within 10-12 hours of the most recent injection. </li></ul><ul><li>LMWH should not be given for four hours after the epidural catheter has been removed </li></ul>Green-top Guideline April 2009
  25. 25. Thank you
  • MohamedMarey7

    Sep. 27, 2021
  • SaraAshraf30

    Nov. 26, 2017
  • MahmudaSumi

    Feb. 3, 2017
  • ToBeDr

    Jul. 25, 2016
  • DrAbrarYasine

    Jul. 16, 2016
  • MohamadAbdlrahman

    Jun. 19, 2016
  • drsakelany

    Mar. 9, 2016
  • AyeshaMahmood4

    Nov. 23, 2015
  • drfarraj

    Jul. 24, 2015

Views

Total views

2,749

On Slideshare

0

From embeds

0

Number of embeds

1

Actions

Downloads

71

Shares

0

Comments

0

Likes

9

×