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VTE in pregnancy

There is a 5- to 10-fold increased risk for VTE during pregnancy. The risk is increased 100-fold in women with previous thrombosis.

In women with heterozygosity for FV Leiden or PGV, and no previous thrombotic history, the absolute risk for pregnancy-associated VTE is low. Women with AT deficiency, PC deficiency, PS deficiency, homozygosity for FV Leiden, homozygosity for PGV, or compound heterozygosity are at higher risk.

Women should be clinically assessed for risk of pregnancy-associated VTE. Testing for heritable thrombophilia is not generally required. Women with a previous unprovoked VTE should be tested for the presence of antiphospholipid antibodies.

In women with a VTE during pregnancy a screen for heritable thrombophilia (FV Leiden, PGV, AT deficiency, PC deficiency, PS deficiency) should be carried out 6 to 8 weeks after discontinuation of antithrombotic therapy. Screening for antiphospholipid syndrome should also be performed.

It may be clinically informative to test asymptomatic women with a family history of VTE if a thrombosis in a first-degree relative was unprovoked, or provoked by pregnancy, COCP use, or a minor risk factor, particularly if this is associated with a known thrombophilia.

Women with a family history of VTE and either AT deficiency or where a specific thrombophilia has not been detected should be tested for antithrombin deficiency.