Postpartum hypercoagulability and prophylaxis anticoagulants

Blood Clot. [Source]

There is an increase in thromboembolic complications because of the hypercoagulability that exists postpartum.

Pregnancy itself is a factor of hypercoagulability (pregnancy-induced hypercoagulability) as a physiologically adaptive mechanism to prevent postpartum hemorrhage.
However, when combined with an additional underlying hypercoagulable states, the risk of thrombosis or embolism may become substantial.

Anticoagulants may be necessary during pregnancy to prevent or control the following:

• venous thrombosis, 
• pulmonary embolism, 
• rheumatic mitral valve disease, 
• prosthetic heart valves,
• peripartum cardiomyopathy, 
• primary pulmonary hypertension and 
• Eisenmenger’s syndrome.

Wells Clinical Prediction Rule for Pulmonary Embolism and Deep Venous Thrombosis

Wells Clinical Prediction Rule for Pulmonary Embolism (PE) 

 

Clinical feature	Points
Clinical symptoms of DVT	3
Other diagnosis less likely than PE	3
Heart rate greater than 100 beats per minute	1.5
Immobilization or surgery within past 4 weeks	1.5
Previous DVT or PE	1.5
Hemoptysis	1
Malignancy	1
Total points

 

PE = pulmonary embolism; DVT = deep venous thrombosis.

Risk score interpretation (probability of PE):

• >6 points: high risk (78.4%);
• 2 to 6 points: moderate risk (27.8%);
• <2 points: low risk (3.4%)

 

Wells Clinical Prediction Rule for Deep Venous Thrombosis (DVT) 

Clinical feature	Points
Active cancer (treatment within 6 months, or palliation)	1
Paralysis, paresis, or immobilization of lower extremity	1
Bedridden for more than 3 days because of surgery (within 4 weeks)	1
Localized tenderness along distribution of deep veins	1
Entire leg swollen	1
Unilateral calf swelling of greater than 3 cm (below tibial tuberosity)	1
Unilateral pitting edema	1
Collateral superficial veins	1
Alternative diagnosis as likely as or more likely than DVT	-2
Total points

DVT = deep venous thrombosis.

Risk score interpretation (probability of DVT):

• >/=3 points: high risk (75%);
• 1 to 2 points: moderate risk (17%);
• <1 point: low risk (3%).