European guidelines on perioperative venous thromboembolism prophylaxis: Surgery during pregnancy and the immediate postpartum period

Eur J Anaesthesiol. 2018 Feb;35(2):130-133. doi: 10.1097/EJA.0000000000000704.

Abstract

: Thromboembolic events in the pregnant and postpartum patient remain rare but potentially fatal complications. The aim of this section was to analyse the few prospective studies addressing the issue of thromboprophylaxis following a surgical procedure during and immediately after pregnancy, as well as national guidelines, and to propose European guidelines on this specific condition. Thromboprophylaxis is broadly recommended due to the combined risks of surgery and pregnancy or the postpartum period, regardless of the mode of delivery. We recommend prophylactic thromboprophylaxis following surgery during pregnancy or the postpartum period when they imply, as a consequence, bed rest, until full mobility is recovered (Grade 1C). Similarly, thromboprophylaxis should be used in cases of perioperative infection during pregnancy or the postpartum period. Concerning thromboprophylaxis following a caesarean section, it seems avoidable only in elective procedures in low-risk patients, after a normal pregnancy, and with an early rehabilitation protocol. The duration of thromboprophylaxis following caesarean section should be at least 6 weeks for high-risk patients, and at least 7 days for the other patients requiring anticoagulation (Grade 1C).

Publication types

  • Practice Guideline

MeSH terms

  • Adult
  • Anesthesiology / methods
  • Anesthesiology / standards
  • Anticoagulants / administration & dosage
  • Anticoagulants / adverse effects
  • Anticoagulants / standards
  • Bed Rest / standards
  • Cesarean Section / adverse effects*
  • Critical Care / methods
  • Critical Care / standards
  • Elective Surgical Procedures / adverse effects*
  • Europe
  • Female
  • Heparin, Low-Molecular-Weight / administration & dosage
  • Heparin, Low-Molecular-Weight / adverse effects
  • Heparin, Low-Molecular-Weight / standards
  • Humans
  • Perioperative Care / methods
  • Perioperative Care / standards*
  • Postnatal Care / methods
  • Postnatal Care / standards*
  • Postpartum Period
  • Pregnancy
  • Pregnancy Complications / surgery*
  • Risk Factors
  • Societies, Medical / standards
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control*

Substances

  • Anticoagulants
  • Heparin, Low-Molecular-Weight