Grant: Project Grant

Pregnant women are on daily injectable blood thinners if they are at risk of a blood clot in their legs (deep vein thrombosis) or lungs (pulmonary embolism) during pregnancy. This includes patients who have already had a blood clot, or those at risk of blood clots. While being on blood thinners helps to prevent blood clots, it can lead to complications at the time of labor and delivery. Being on blood thinners may increase the chance of heavier bleeding at the time of delivery, and may limit the ability to get an epidural anesthesia for pain control. Being off of blood thinners may increase the chance of getting a blood clot. Around the world, physicians recommend different strategies for what to do with the blood thinners around labor and delivery, and we do not know what the best strategy is. We will we follow pregnant women on injectable blood thinners at 13 hospitals around the world, to see what happens with their blood thinners at the time of labor and delivery, and the postpartum period. We will get blood work to measure a blood count and blood thinner level on the day of delivery, and a blood count 24 hours after delivery. We will collect information about the amount of blood lost at the time of delivery and other delivery details. We will see or call participants at 6 weeks and 90 days postpartum to assess for complications of bleeding, blood clots, and wound complications. Because the patient experience is very important, we will also ask participants about the choices they made and satisfaction with their delivery experience. We will also collect information about hospital resources used with each of the different management strategies. By better understanding what practices are happening around the world and collecting outcome information in a similar way at all participating centres, we can provide doctors and patients with more information about the risks and benefits of the different options of blood thinner management around delivery.