Thromboprophylaxis in Pregnancy and the Puerperium: Physiology, Evidence, Guideline Discordance and Research Gaps: A Narrative Review

Abstract

Venous thromboembolism (VTE) is a leading direct cause of maternal death and among the most preventable. Pregnancy satisfies every element of Virchow's triad-a progressive procoagulant shift with suppressed fibrinolysis, mechanical venous stasis, and endothelial injury at delivery-and risk peaks in the puerperium rather than during gestation. Yet the translation of this well-characterised physiology into prophylaxis policy has proved remarkably contentious.