The risk of venous thromboembolism (VTE) increases during pregnancy and postpartum. A deep vein thrombosis (DVT) will often present with unilateral extremity swelling or pain and the skin may be erythematous and warm to palpation. Approximately 75-80% of pulmonary embolisms are caused by DVT. Symptoms include shortness of breath, chest pain that worsens with deep inspiration, hemoptysis, and palpitations. On evaluation, tachycardia and lowered oxygen saturation can be seen. Clinicians need to have a high index of suspicion. Workup includes a venous duplex ultrasound of the affected area, a ventilation-perfusion (v/q) scan, or a CT angiogram. Once the VTE is confirmed or highly suspected, unfractionated heparin should be started per protocol.
Heparin | Dose Level | Dose |
LMW heparin | Therapeutic | Enoxaparin 1 mg/kg SC every 12 hours Dalteparin 100 units/kg SC every 12 hours |
Unfractionated heparin | Therapeutic | Can be given as a continuous IV infusion or an SC dose every 12 hours. Titrated to keep the aPTT in the therapeutic range. |