Postpartum issues
As discussed previously, therapeutic anticoagulant treatment for gestational VTE should be continued for the duration of the pregnancy, for at least 6 weeks postpartum, and for at least 3 months total duration.
The use of LMWH for more than 12 weeks is associated with a significantly lower risk of developing post-thrombotic syndrome. Before discontinuing treatment the risk of recurrent thrombosis should be assessed. As warfarin does not cross the breast in significant amounts it can be used postpartum for anticoagulation. However, because of bleeding risks, especially at the transition between LMWH and warfarin in the postpartum period (26), it is best to avoid starting warfarin until at least the fifth postpartum day and for longer where there is an increased risk of postpartum haemorrhage. Therefore, women can be offered a choice of LMWH or warfarin for postpartum therapy. In contrast to LMWH, warfarin will require regular monitoring with the INR particularly during the first 10 days of treatment, which may be problematic for a woman with a young baby.
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