Treatment of PE in Pregnancy

LMWH is the treatment of choice for PE in pregnancy. In pregnancy the pharmacokinetics of LMWH is altered and a twice daily regime is indicated. The dose of Enoxaparin is 1mg/kg b.d. in this situation. Unfractionated heparin is associated with osteoporosis and thrombocytopenia and is not recommended for prolonged use. Unfractionated heparin is reserved for cases of massive PE (where it may be used in combination with thrombolysis).

Oral anticoagulation is not given during pregnancy due to a greater bleeding risk and teratogenic risks to the developing foetus. A temporary IVC filter may be inserted prior to delivery as anticoagulation will need to be stopped due to the risk of haemorrhage. When VTE occurs in the antepartum period, delivery should be delayed, if possible, to allow maximum time for anticoagulation rather than putting in a filter.

Learning Bite

LMWH should be administered twice daily for patients with PE in pregnancy.