Detection of Thrombophilia in Pregnancy

Indications for Thrombophilia Detection

Women with a history of venous thromboembolism (VTE) should be evaluated for thrombophilia, according to the American College of Chest Physicians 1, 2
Women receiving long-term anticoagulation with vitamin K antagonists should be evaluated for thrombophilia, as recommended by the American College of Chest Physicians 1, 3
Women with a family history of VTE and known thrombophilia should be evaluated for thrombophilia, according to the American College of Chest Physicians 1, 3
Women with recurrent early pregnancy loss (three or more spontaneous abortions before 10 weeks of gestation) should be evaluated for antiphospholipid antibodies (APLA), as recommended by the American College of Chest Physicians 1, 4

Factor V Leiden (homozygous or heterozygous) should be tested in women with a history of VTE or family history of VTE, as recommended by the American College of Chest Physicians 3
Prothrombin G20210A mutation should be tested in women with a history of VTE or family history of VTE, as recommended by the American College of Chest Physicians 3
Protein C deficiency should be tested in women with a history of VTE or family history of VTE, as recommended by the American College of Chest Physicians 3
Protein S deficiency should be tested in women with a history of VTE or family history of VTE, as recommended by the American College of Chest Physicians 3
Antithrombin deficiency should be tested in women with a history of VTE or family history of VTE, as recommended by the American College of Chest Physicians 3
Antiphospholipid antibodies should be tested in women with recurrent early pregnancy loss, as recommended by the American College of Chest Physicians 1

For women homozygous for factor V Leiden or prothrombin 20210A mutation with a family history of VTE, antepartum prophylaxis with low-molecular-weight heparin (LMWH) at prophylactic or intermediate doses is recommended, according to the American College of Chest Physicians 1, 3
For women with other thrombophilias and a family history of VTE, clinical surveillance during pregnancy and postpartum prophylaxis with LMWH at prophylactic or intermediate doses or vitamin K antagonists (INR 2.0-3.0) are recommended, according to the American College of Chest Physicians 1, 3

Women receiving long-term anticoagulation with vitamin K antagonists should switch to LMWH adjusted by dose or 75% of the therapeutic dose throughout pregnancy, as recommended by the American College of Chest Physicians 1, 3
For women with antiphospholipid syndrome and recurrent pregnancy loss, combined therapy with aspirin and heparin is recommended, according to the American College of Chest Physicians 1, 5
Antithrombotic prophylaxis is not recommended for women with hereditary thrombophilias and a history of pregnancy complications without other risk factors, as stated by the American College of Chest Physicians 1, 3