High risk pregnancies in MPN patients and indications for anticoagulation and cytoreduction
| Indications for anticoagulation |
| • Prior indication for anticoagulation: switch to therapeutic LMWH • Prior thrombotic event included estrogen-related: consider prophylactic LMWH • Concomitant high-risk thrombophilia +/- family history of thrombosis: consider prophylactic LMWH • IVF pregnancy (first 12 weeks): consider prophylactic LMWH |
| Indications for cytoreduction |
| • Prior indication for cytoreduction: switch to IFN • >3 unexplained consecutive pregnancy losses at <10 weeks: consider cytoreduction • >1 late pregnancy losses at >10 weeks: consider cytoreduction • Prior pregnancy complications including severe preeclampsia and placental insufficiency leading to <34 week fetus with IUGR: consider cytoreduction • Inability to maintain Hct at <45% with therapeutic phlebotomy: consider cytoreduction • Extreme thrombocytosis with acquired von Willebrand: consider cytoreduction • Significant antepartum or postpartum hemorrhage: consider cytoreduction |
| Indications for anticoagulation |
| • Prior indication for anticoagulation: switch to therapeutic LMWH • Prior thrombotic event included estrogen-related: consider prophylactic LMWH • Concomitant high-risk thrombophilia +/- family history of thrombosis: consider prophylactic LMWH • IVF pregnancy (first 12 weeks): consider prophylactic LMWH |
| Indications for cytoreduction |
| • Prior indication for cytoreduction: switch to IFN • >3 unexplained consecutive pregnancy losses at <10 weeks: consider cytoreduction • >1 late pregnancy losses at >10 weeks: consider cytoreduction • Prior pregnancy complications including severe preeclampsia and placental insufficiency leading to <34 week fetus with IUGR: consider cytoreduction • Inability to maintain Hct at <45% with therapeutic phlebotomy: consider cytoreduction • Extreme thrombocytosis with acquired von Willebrand: consider cytoreduction • Significant antepartum or postpartum hemorrhage: consider cytoreduction |
IUGR, intrauterine growth restriction.