Venous Thromboembolism Prophylaxis in Pregnancy: Why are the U.S. and European Guidelines so Different? Recent Studies and Clinical Insights

Approaches to venous thromboembolism (VTE) prophylaxis in pregnancy and the postpartum period greatly differs across U.S. and European guidelines. The goal of this review is to identify why these discrepancies exist and to guide healthcare providers’ clinical decision making for how their individual institutions approach VTE prophylaxis in obstetric patients.

There is a paucity of evidence guiding the use of VTE prophylaxis in obstetric populations. This limitation results from the difficulty of performing the randomized control studies in pregnant populations needed to obtain this data. As regards the use of pharmaceutical thromboprophylaxis, it is largely agreed upon that low molecular weight heparin (LMWH) is the preferred anticoagulant agent in pregnancy. Additionally, studies have demonstrated poor patient adherence to mechanical VTE prophylaxis.

Based on available U.S. and European guidelines for VTE prophylaxis in pregnancy and the postpartum period, as well as our clinical experience, we recommend individualized institutional protocols utilizing patient VTE risk stratification to determine indicated secondary VTE prevention measures. In hospitalized obstetric patients, we recommend the use of LMWH over mechanical prophylaxis (i.e. sequential compression devices) given generally poor adherence and decreased efficacy, with shared decision making with the patient.