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innohep®

tinzaparin sodium

Get ready to meet your new friend

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“A baby is something you carry inside you for nine months, in your arms for three years, and in your heart until the day you die.”

Mary Mason

Antenatal assessment and management (to be assessed at booking and repeated if admitted)

Any previous VTE except a Single event related to major surgery

                <p style="text-align: center;"><strong>HIGH RISK</strong></p><p style="text-align: center;"><strong>Requires antenatal prophylaxis with LMWH</strong>refer to trust-nominated thrombosis in pregnancy expert/team

Hospital admission

Single previous VTE related to major surgery

High-risk thrombophilia + no VTE

Medical comorbidities e.g. cancer, heart failure, active SLE, IBD or inflammatory polyarthropathy, nephrotic syndrome, type 1 DM with nephropathy, sickle cell disease, current IVDU

Any surgical procedure e.g. appendicectomy

OHSS(first trimester only)

INTERMEDIATE RISK

Consider antenatal prophylaxis with LMWH

Obesity (BMI > 30KG/M2)AgeParity ≥ 3SmokerGross varicose veinsCurrent pre-eclampsiaImmobility, e.g. paraplegia, PGPFamily history of unprovoked or estrogen-provoked VTE in first-degree relativeLow-risk thrombophiliaMultiple pregnancyIVF/ART

Transient risk factors:

Dehydration/hyperemesis; current systemic infection; long-distance travel

Fewer than three risk factors

Four or more risk factors:Prophylaxis from first trimesterThree risk factors:Prophylaxis from 28 weeks

LOWER RISK

Mobilisation and avoidance of dehydration

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For more information

Regarding the timing of first antenatal and/or postnatal thromboprophylactic dose; please refer to RCOG Green-Top Guideline No. 37a (thrombosis and Embolism during Pregnancy and the Puerperium, Reducing the risk – Published 13/04/2015)

Postnatal assessment and management (to be assessed on delivery suite)

Any previous VTEanyone requiring antenatal LMWHHigh-risk thrombophiliaLow-risk thrombophilia + FHx

HIGH RISK

At least 6 weeks, postnatal prophylactic LMWH

caesarean section in labour

BMI ≥ KG/M2

Readmission or prolonged admission (≥3 days) in the puerperium

Any surgical procedure int the puerperium except immediate repair of the perineum

Medical comorbidities e.g. cancer, heart failure, active SLE, IBD or inflammatory polyarthropathy, nephrotic syndrome, type 1 DM with nephropathy, sickle cell disease, current IVDU

INTERMEDIATE RISK

At least 10 days postnatal prophylaxis with LMWH

NB if presisting > 3 risk factors; consider extending thromboprophylaxis with LMWH

Age > 35 yearsObesity (BMI > 30KG/M2)Parity ≥ 3SmokerElective caesarean sectionFamily history of VTELow-risk thrombophiliaGross varicose veinsCurrent systemic infectionCurrent pre-eclampsiaImmobility, e.g. paraplegia, PGP, long-distance travelMultiple pregnancyPreterm delivery in this pregnancy (<37+0 weeks)Stillbirth in this pregnancyMid-cavity rotational or operative deliveryProlonged labour (< 24 hours)PPH > 1 litre or blood transfusionFamily history of unprovoked or estrogen-provoked VTE in first-degree relativeLow-risk thrombophiliaMultiple pregnancyIVF/ARTTwo or more risk factorsFewer than two risk factors

LOWER RISK

Mobilisation and avoidance of dehydration

Antenatal and post natal prophylactic dose of LMWH

Weight < 50KG = 20MG enoxaparin / 2500UNITS dalteparin / 3500UNITS tinzaparin daily.Weight 50-90KG = 40MG enoxaparin / 5000UNITS dalteparin / 4500UNITS tinzaparin daily.Weight 91-130KG = 60MG enoxaparin / 7500UNITS dalteparin / 7000UNITS tinzaparin daily.Weight 131-170KG = 80MG enoxaparin / 10000UNITS dalteparin / 9000UNITS tinzaparin daily.Weight > 170KG = 0.6MG/KG enoxaparin / 75UNITS/KG dalteparin / 75UNITS/KG tinzaparin daily.