This page is a quick reference for anticoagulant options, dosing intensity terminology (prophylactic / intermediate / adjusted-dose), monitoring considerations, and common peripartum / neuraxial timing summaries used in pregnancy and postpartum care.
For Table 3 scenario-by-scenario recommendations, see ACOG PB 196 and your institution’s VTE pathway (including neuraxial anesthesia policy).
Dose “intensity” labels (prophylactic / intermediate / adjusted-dose) are used by ACOG and similar guidance. Specific dose adjustments may be needed for BMI extremes, renal impairment, bleeding risk, and local formulary. Prophylactic and treatment dose examples align with commonly cited ACOG definitions and drug labeling.
| Agent | Prophylactic dose (example) | Intermediate dose (example) | Therapeutic / adjusted-dose (example) | Monitoring notes | Label |
|---|---|---|---|---|---|
| Enoxaparin (LMWH) | 40 mg SC once daily | 40 mg SC q12h | 1 mg/kg SC q12h (common in pregnancy) or 1.5 mg/kg SC daily (label option) |
No routine monitoring for most. Consider anti-Xa in extremes of weight, renal impairment, recurrent VTE, or selected high-risk scenarios. |
DailyMed |
| Dalteparin (LMWH) | 5,000 units SC once daily | 5,000 units SC q12h | Therapeutic dosing varies by protocol (commonly 100 units/kg q12h or 200 units/kg daily) |
Similar to LMWH class: usually no routine monitoring. Consider anti-Xa selectively (same considerations as above). |
DailyMed |
| Tinzaparin (LMWH) | 4,500 units SC once daily | (protocol-based) | Therapeutic dosing varies (commonly 175 units/kg daily per protocols) | Similar LMWH monitoring considerations (anti-Xa selective). | DailyMed |
| Unfractionated heparin (UFH) | 5,000 units SC q12h (sometimes q8–12h by protocol/trimester) | (protocol-based) | IV infusion with weight-based bolus/infusion per VTE treatment nomogram (institution-specific) |
Therapeutic UFH: monitor aPTT or anti-Xa per institutional nomogram; monitor platelets for HIT risk. Prophylactic UFH SC: usually no aPTT monitoring. |
DailyMed |
Two overlapping considerations: (1) postpartum bleeding/hemostasis and (2) neuraxial anesthesia safety. Always follow local anesthesia + OB protocols, especially if neuraxial catheter is in place.
Practical summary of commonly cited anesthesia guidance for neuraxial procedures and postpartum dosing, plus ACOG’s postpartum restart window. If neuraxial is planned/likely, coordinate timing early.
| Regimen | Hold before neuraxial placement / planned delivery | Restart after neuraxial procedure / catheter removal | Postpartum restart (hemostasis) |
|---|---|---|---|
| LMWH prophylactic (e.g., enoxaparin 40 mg daily) |
Typically ≥ 12 hours after last dose before neuraxial placement (ASRA-derived summaries) | Common summary: start ≥ 4 hours after catheter removal and not < 12 hours after neuraxial block | ACOG PB 196: ≥ 4–6 h after vaginal OR ≥ 6–12 h after cesarean (if hemostasis secure) |
| LMWH therapeutic / higher-dose (e.g., enoxaparin 1 mg/kg q12h) |
Typically ≥ 24 hours after last dose before neuraxial placement (ASRA-derived summaries) | Common summary: start ≥ 4 hours after catheter removal and not < 24 hours after neuraxial block | ACOG window applies; higher-dose restart often individualized based on bleeding risk and surgical factors. |
| UFH prophylactic (SC) (e.g., 5,000 units q8–12h) |
Often 4–6 hours after last dose before neuraxial placement (protocol-dependent) | Common summary: may restart ≥ 1 hour after neuraxial catheter removal (protocol-dependent) | ACOG window applies (hemostasis-based) |
| UFH therapeutic (IV infusion) | Typically stop infusion 4–6 hours prior and confirm coagulation normalization per anesthesia protocol | Restart per anesthesia/OB protocol once safe relative to neuraxial and bleeding risk | ACOG window applies; higher-dose therapy should be individualized. |
