This algorithm applies to individuals with known inherited thrombophilia (factor V Leiden or prothrombin G20210A; protein S, protein C, or AT deficiency). It is a general overview of our approach and does not substitute for clinical judgment regarding the risks and benefits of anticoagulation for an individual patient. Consultation with a hematologist may be appropriate.
- Individuals with AT deficiency may have heparin resistance, and, if they require anticoagulation, it may be necessary to use a nonheparin anticoagulant and/or to provide AT replacement along with appropriate doses of heparin. Refer to the UpToDate topic on AT deficiency for details.
- Routine obstetrical care includes mechanical thromboprophylaxis and/or anticoagulation for women undergoing cesarean delivery. Routine postoperative care includes thromboprophylaxis in most cases; individuals with thrombophilia may require more aggressive prophylaxis than those without. Refer to UpToDate for indications for thrombophilia testing and other aspects of obstetric and postoperative management.
- Routine perioperative care includes thromboprophylaxis based on the procedure-associated risk of VTE.
- Atypical sites of VTE include mesenteric, portal, and cerebral veins.