Table 1
Anticoagulation recommendations during pregnancy in the pre- and postpartum phase. UFH: unfractionated heparin; LMWH: low-molecular-weight heparin; VKA: vitamin K agonists; DOAC: direct oral anticoagulant
| PRE- AND POST-PARTUM ANTICOAGULATION TREATMENT TIMELINE IN PE | |
|---|---|
| DURATION | CHOICE OF ANTICOAGULANT |
| Acute | UFH |
| 0-days | LMWH* |
| Standard Pre-partum | LMWH* |
| Post-partum ** | |
| 6 weeks – 3 months | LMWH |
| Breast feeding | VKA |
| Not breast feeding | LMWH |
| VKA | |
| DOAC | |
[i] *Fondaparinux can replace low-molecular-weight heparin when contraindicated.
**Continuation of therapy should consider persistent risk factors and timelines as depicted in Table 2.
Figure 1
Algorithm summarizing the options of anticoagulation for patients with pulmonary embolism. PE: pulmonary embolism; DOAC: direct oral anticoagulant; LMWH: low-molecular-weight heparin; UFH: unfractionated heparin; VKA: vitamin K agonists; MPFF: micronized purified flavonoid fraction; ASA: acetylsalicylic acid
* Full dose direct oral anticoagulants or reduced dose as per trials
** Usually at the reduced dose
Table 2
Time segments for evaluation of anticoagulation therapy in patients with pulmonary embolism. PE: pulmonary embolism; ASA: aspirin; DOAC: direct oral anticoagulant; LMWH: low-molecular-weight heparin; UFH: unfractionated heparin; VKA: vitamin K agonists; ASA: acetylsalicylic acid
| ANTICOAGULATION TREATMENT TIME SEGMENTS IN PE | ||
|---|---|---|
| DURATION | CHOICE OF ANTICOAGULANT | COMMENTS |
| Primary 3 months | DOAC | Initial low risk patients and all post intervention |
| LMWH | Parenteral anticoagulation with initiation of certain | |
| UFH/LMWH to VKA | DOACs and VKA | |
| Maintenance 3-12 months | DOAC | Allows for continued fibrinolysis or recanalization |
| LMWH | Supported by various trials at standard or reduced dose | |
| VKA | VKA for special populations | |
| Extended/lndefinite 6-12 months - years | DOAC | Reduced DOAC dosing |
| VKA | ASA or sulodexide when off anticoagulation | |
| ASA | Indefinite anticoagulation in special populations | |
| Sulodexide | ||