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

Ducloy-Bouthors, Anne-Sophie; Baldini, Andrea; Abdul-Kadir, Rezan; Nizard, Jackyfor the ESA VTE Guidelines Task Force

European Journal of Anaesthesiology (EJA): February 2018 - Volume 35 - Issue 2 - p 130–133
doi: 10.1097/EJA.0000000000000704

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).

From the Pole d’Anesthésie-Réanimation, CHRU Lille, France (ASDB), IFCA Institute, Orthopaedics Department, Florence, Italy (AB), Institute of Women's Health, UCL, London, UK (RAK) and Department of Obstetrics and Gynecology, Groupe hospitalier Pitié-Salpêtrière Paris, Assistance Publique Hôpitaux de Paris, France (JN)

Correspondence to Anne-Sophie Ducloy-Bouthors, Pole d’Anesthésie-Réanimation, Maternité Jeanne de Flandre, CHRU, 59037 Lille, Cedex, France E-mail:

Published online 6 November 2017

© 2018 European Society of Anaesthesiology