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Managing anticoagulation peripartum.

Arielle L Langer1, Brandon Togioka2, Nicole A Smith3

  • 1Division of Hematology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Journal of Thrombosis and Haemostasis : JTH
|September 27, 2025
PubMed
Summary
This summary is machine-generated.

Managing anticoagulation during pregnancy requires careful planning to balance thrombosis risks with postpartum hemorrhage concerns. Personalized delivery strategies involving multiple specialists ensure safe outcomes for expectant mothers on anticoagulants.

Keywords:
anticoagulantsperipartum periodpregnancyvenous thromboembolism

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Area of Science:

  • Obstetrics and Gynecology
  • Hematology
  • Anesthesiology

Background:

  • Anticoagulants are frequently used during pregnancy due to increased thrombosis risk.
  • Peripartum anticoagulation management is complex, requiring a balance between therapeutic benefits and hemorrhage risks.
  • Neuraxial anesthesia availability can be limited for patients on anticoagulation.

Purpose of the Study:

  • To outline key considerations for delivery planning in pregnant patients on anticoagulation.
  • To emphasize the importance of multidisciplinary collaboration for safe peripartum anticoagulation management.
  • To review postpartum anticoagulation strategies for venous thromboembolism.

Main Methods:

  • Review of current literature and clinical guidelines on peripartum anticoagulation.
  • Discussion of factors influencing delivery decisions, including dosing, delivery mode, and anesthesia.
  • Consideration of patient preferences and specific clinical scenarios.

Main Results:

  • Delivery planning involves evaluating prophylactic vs. therapeutic dosing, delivery mode, and timing.
  • Patient-specific factors like neuraxial anesthesia indications and patient values are crucial.
  • Transitioning to different anticoagulation methods (e.g., heparin infusions) may be necessary before delivery.

Conclusions:

  • Optimal peripartum anticoagulation requires prenatal collaboration among thrombosis experts, obstetricians, and anesthesiologists.
  • Personalized delivery plans are essential to mitigate thrombosis and hemorrhage risks while respecting patient preferences.
  • Adherence to postpartum anticoagulation is critical during this high-risk period.