2002 Dec;79(3):299-300. doi: 10.1016/s0020-7292(02)00351-x. Int J Gynaecol Obstet. Diagnosing DVT is difficult during pregnancy. Despite these potential risks of UFH, most practitioners continue to switch pregnant women from LMWH to UFH in the third trimester because of the advantage of easy reversal of UFH with protamine sulfate and the short half-life of UFH compared to LMWH in the event of imminent delivery at term. There were no statistically significant differences in peripartum anesthesia requirement and significant peripartum bleeding between women who continued LMWH and those who switched to UFH (82.4% vs. 79.7%, respectively; relative risk [RR], 1.20; 95% confidence interval [CI], 0.52-2.73; P = 0.84). There are so many sacrifices you make for your baby during pregnancy, and for some women that looks like a belly covered in tiny bruises and an extra dose of self-care after each stick. All of the relevant financial relationships listed for these individuals have been mitigated. Our All Access Subscription provides unlimited access to our entire publication Natural cycle Dec 2010 BFP M/C 6 1/2 Weeks, D&E Jan 2011, DQ ALPHA HLA MATCH, High NK Cells Diagnosed Dec 2011. Accessibility Clipboard, Search History, and several other advanced features are temporarily unavailable. Clinical suspicion is confirmed in 10 percent of pregnant women, compared with 25 percent of nonpregnant patients. The safety of antithrombotic therapy during pregnancy. American College of Obstetricians and Gynecologists Committee on Practice Bulletins--Obstetrics. I have my Lovenox ready to go for tomorrow, but I have no clue what time I should take it. Before sharing sensitive information, make sure youre on a federal . ACOG Practice Bulletin No. Stellbrink C, Nixdorff U, Hofmann T, Lehmacher W, Daniel WG, Hanrath P, Geller C, Mgge A, Sehnert W, Schmidt-Lucke C, Schmidt-Lucke JA; ACE (Anticoagulation in Cardioversion using Enoxaparin) Study Group. Pharmacotherapy. Venous thromboembolism (blood clots) and pregnancy. Read our. I've been gradually making my shot 15-20 minutes earlier each day and I'm down to about 8:50 now. no history of haemorrhaging but out of 3 people being induced that day who were previously on Heparin I was the only one who did! Heparin sodium and sodium chloride 0.9% injection. Copyright 2023 American Academy of Family Physicians. The good news with heparin is that it is reversible and it lasts only half the time (12 hours) as opposed to a Lovenox which lasts 24 hours. The Society for Obstetric Anesthesia and Perinatology consensus statement on the anesthetic management of pregnant and postpartum women receiving thromboprophylaxis or higher dose anticoagulants. Accessibility v SB V%2Uak+:d!D NU3~0t$5Vm;2 7 Clinical presentation varies from mild dyspnea and tachypnea to dramatic cardiopulmonary collapse. I'm going to aim for about 7 am and 7 pm. Therapeutic anticoagulation is indicated when DVT or PE is diagnosed. Why Your Feet Swell During PregnancyAnd How to Get Some Relief, How to Get the Most Out of Compression Socks During Pregnancy, Experts Weigh In on Whether Pregnant People Should Get the COVID-19 Booster Shot, Maternal Mortality Rate, Causes, and Prevention. Enoxaparin: the low-molecular-weight heparin for prevention of postoperative thromboembolic complications. Low-molecular-weight heparin has largely replaced unfractionated heparin for prophylaxis and treatment in pregnancy. With life-threatening PE, thrombolytic therapy, percutaneous catheter thrombus fragmentation, or surgical embolectomy may be used, depending on local resources.33 Good evidence about the effectiveness and safety of thrombolytic therapy is lacking.34 Empiric anticoagulation may be started if clinical suspicion is high, then discontinued if VTE is excluded.12. Among the more serious risks are blood clots, or thrombosis. Women who are on Lovenox injections during pregnancy, are usually kept on them for 6-8 weeks postpartum to avoid postpartum clotting or DVT. hmO0?nB_b*@$Z*R$xm4B 2008 Jun;25(6):585-94. doi: 10.1007/s12325-008-0068-0. You have reached your article limit for the month. Diagnosing DVT is difficult during pregnancy. Epub 2009 Aug 14. Dr. Gerard Honore answered. You will likely be a little over thinned the first day but that's normal. As you look into treatments, including using Lovenox, your doctor or midwife will know what the best option is for you and your growing baby. Bone status of children born from mothers with autoimmune diseases treated during pregnancy with prednisone and/or low molecular weight heparin. An alternative option for women on either prophylactic or adjusted-dose LMWH may be to stop anticoagulation and induce labor within 12 to 24 hours respectively, if clinically appropriate 4. I didnt want to risk a Friday evening injection. You don't currently have a subscription to allow access to this publication. No, they don't have any plans of induction. 1993 Oct;27(10):1223-30. doi: 10.1177/106002809302701013. LMWHs are the agents of choice for antenatal thromboprophylaxis. Do you think it's ok to keep doing that so that when I switch in 1.5 weeks, my body has a semi consistent amount in its system? Is Black Race Associated with Major Depression Following Early Pregnancy Loss? I'm switching to Heparin shortly and the doctor told me it will be twice a day. Continuous IV infusion for a total of at least 30,000 IU over 24 hours, Monitor aPTT and adjust dose to maintain aPTT 1.5 to 2 times control value, DVT or PE with thrombogenic event (e.g., hip fracture, prolonged surgery), Antithrombin deficiency, homozygous factor V Leiden; two or more minor risk factors (i.e., heterozygous factor V Leiden and heterozygous prothrombin G20210A mutations), Single heterozygous factor V Leiden or heterozygous prothrombin G20210A mutation. Additionally, enoxaparin should be used with caution or discontinued before administration of epidural for pain relief during labor. Baylor Scott & White Medical Center McKinney, Baylor Scott & White Medical Center Frisco, Texas Health Presbyterian Hospital of Flower Mound. Ann Pharmacother. Curr Opin Obstet Gynecol. I am also extremely worried about the risk of hemorrhage. . I started thinking about it and realized I can't do it at 9:45 and 9:45 because of my work schedule. [The risk of bleeding associated with low molecular weight heparin in patients with renal failure]. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. dontletitbeabouttom 2 yr. ago. A potential risk of a global shortage of the supply of active pharmaceutical ingredients used for heparin products is being monitored on an international level 1. It is not necessary to follow the activated partial thromboplastin time.10 Anti-Xa levels need only be obtained in patients who are at extremes of weight (< 121 lb [55 kg] or > 198 lb [90 kg]) or have abnormal renal function.12 Monitoring of platelets while on LMWH is no longer recommended.12 UFH may be used instead of LMWH for the treatment of VTE in pregnancy, because of cost or availability. Taking Lovenox during pregnancy has some risks. It is not intended to substitute for the independent professional judgment of the treating clinician. Epidural safe? FOIA I usually take it around 9:45-10:15 at night. Aside from that, I haven't had any issues. ;0j,s8mmLTqon 'KfC/8#ygsB"k'^R{ \5g39g-,w7dW$.U "y_'Uzo.j>6{DL$Km+x%17+Wj8aF`La!A2oR#2j P 7lVS-fD0:+T^U@CTQ*RIY Read terms. Pharmacotherapy. Brian Levine, MD, MS, FACOG, is board-certified in obstetrics-gynecology, as well as reproductive endocrinology and infertility (REI). Effective dosing is something to discuss with your doctor as medication dosing is often made on a case-by-case basis. Venous thromboembolism and anticoagulant therapy in pregnancy. I don't look forward to the 2x a day shots. Committee on Obstetric Practice. You want to know the best way to treat these blood clots and want this information as soon as possible. An official website of the United States government. See permissionsforcopyrightquestions and/or permission requests. Disclaimer. Heparin works in a slightly different way so you can just switch over. LMWHs are replacing UFH as the first-choice medications for VTE treatment and prophylaxis in pregnancy.12,24,35 In nonpregnant women, randomized trials have shown LMWHs to have equivalent or better effectiveness compared with UFH.1,3,36 In pregnancy, a systematic review concluded that LMWH is safe and effective and that there is no evidence to favor one LMWH over another.35 Excretion in breast milk is minimal.37 Compared with UFH, LMWHs have lower rates of adverse effects, including heparin-induced thrombocytopenia, symptomatic osteoporosis, bleeding, and allergic reactions.35, Warfarin should be avoided during pregnancy. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement It crosses the placenta and increases the risk of miscarriage, stillbirth, embryopathy (nasal hypoplasia or stippled epiphyses), central nervous system abnormalities, and maternal and fetal hemorrhage.32 Warfarin is compatible with breastfeeding.32, Data derived from nonpregnant populations suggest that therapeutic anticoagulation following a first episode of VTE should continue for at least six months from diagnosis.38 Current recommendations for the duration of treatment in pregnancy range from three to six months, including six weeks postpartum.10,12,32 Long-term (i.e., longer than 12 months) anticoagulation is indicated for women with VTE and antiphospholipid antibody syndrome, or two or more thrombophilias,39 and for women with any thrombophilia and recurrent thrombotic events.40. I've also had surgery to place a little screen in my body to hopefully catch any blood clots from moving elsewhere in my body to my heart. government site. Please enable it to take advantage of the complete set of features! Lovenox and heparin are both effective for treating and preventing blood-clotting conditions like deep vein thrombosis (DVT) and pulmonary embolism (PE). Multidetector-row (spiral) computed tomography is the test of choice for pulmonary embolism. For additional quantities, please contact [emailprotected] However, the use of enoxaparin and other low-molecular-weight heparins for therapeutic anticoagulation is not recommended for pregnant women with prosthetic heart valves. If untreated, blood clotting during pregnancy can lead to serious conditions like pulmonary embolism (PE), which can be fatal. | Terms and Conditions of Use. Additionally, blood may not flow as easily to the legs during pregnancy as a result of the growing fetus putting pressure on pelvic blood vessels. ACOG Committee Opinion: safety of Lovenox in pregnancy. (Monday through Friday, 8:30 a.m. to 5 p.m. Stop IV heparin and start SQ heparin at the same time Stop IV heparin and the same time Stop IV heparin and Please select a reason for escalating this post to the WTE moderators: Connect with our community members by starting a discussion. Heparin works in a slightly different way so you can just switch over. Our healthy baby girl was born 03/10/15 thanks to daily Lovenox injections and baby aspirin. Disclaimer. van Dongen CJ, van den Belt AG, Prins MH, Lensing AW. If you end up having a blood clot during pregnancy, or if you are at risk of having one, you are likely experiencing high levels of stress, discomfort, and fear. Heparin is typically administered 2 or 3 times a day, but it could be given as often as 6 times a day. Anticoagulation is sometimes needed during pregnancy and/or the postpartum period, including individuals at high risk of deep vein thrombosis, a history of venous thromboembolism, with prosthetic heart valves, atrial fibrillation, left ventricular dysfunction, or a history of fetal loss. Enakpene CA, Pontarelli KN, Della Torre M. Comparison of continuation of low-molecular-weight heparin versus switching to unfractionated heparin in the peripartum. government site. access to 500+ CME/CE credit hours per year, and access to 24 yearly Low-molecular-weight heparins in pregnancy. The use of anticoagulants during pregnancy is problematic because of the potential adverse effects to the mother and the fetus. 2023 Dotdash Media, Inc. All rights reserved, Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. %%EOF Ketamine Use in the Prevention of Postpartum Depression Is Premature, Evaluation and Treatment of Women with Symptoms of Recurrent UTIs, LMWH vs. UFH in Pregnant Women Undergoing Anticoagulation, OB/GYN Clinical Alert Welcomes Maria F. Gallo, PhD. The .gov means its official. Pregnant? Eighty-five pregnancies resulted in 93 of 99 potential live births. Media community. Make sure you're rotating spots so to not make one area more sore than other spots. doi: 10.4103/1817-1737.134050. Available at: Approaches to limit intervention during labor and birth. Gestational age should be an important consideration in decision making surrounding delivery and, if medical management of anticoagulation is the isolated factor driving delivery planning, delivery for that indication alone need not occur before 39 weeks of gestation unless extenuating circumstances exist. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, Pregnancy is a risk factor for deep venous thrombosis, and risk is further increased with a personal or family history of thrombosis or thrombophilia. A retrospective chart review was performed on 72 patients with thrombophilia exposed to the LMWH, enoxaparin, during pregnancy. Movahedi M, Motamedi M, Sajjadieh A, Bahrami P, Saeedi M, Saeedi M. J Cardiovasc Thorac Res. Twenty-seven percent (51 women) were switched to UFH at some point during pregnancy, while 73% (138 women) continued LMWH until the time of delivery. I'm only 13.5 weeks and haven't done this before. You might need to inject the medicine quicker or slower, based on what is the most comfortable for you. All Rights Reserved. (I was taking baby aspirin and Cabergoline to stay regulated while "taking a break from TTC" and waiting to consult with a reproductive immunologist!!!). Silver Spring, MD: FDA; 2020. Learn more about, Twins & Multiples: Your Tentative Time Table. The outcomes of interest were peripartum anesthesia requirements based on the anticoagulant used, and significant peripartum bleeding complications (postpartum hemorrhage > 1,000 mL and severe bleeding complications resulting in hemoperitoneum). Safety of Lovenox in pregnancy. While most pregnancies progress smoothly and without serious medical issues, pregnancy doesnt come without some risk. Maternal complications and pregnancy outcome in women with mechanical prosthetic heart valves treated with enoxaparin. Pain with foot dorsiflexion (Homans' sign) is neither sensitive nor specific for diagnosing DVT in patients who are not pregnant;18 however, data are lacking for this in patients who are pregnant. The doctor plans to induce me at 38 or 39 weeks (still undecided) and I will stay on Lovenox until the day before scheduled induction. Frisco, McKinney, Allen, Fairview,Plano, Prosper, Anna,Dallas, Coppell, Flower Mound, Carrolton,Nevada, Denison, Sherman, Anna, Melissa, Van Alstyne, Celina, Weston, Little Elm, and surrounding North Texas communities. The long half-life of Lovenox means it can be dosed once daily. I wasnt able to get an epidural but that was because they couldnt get the needle in my back. Pregnancy Outcome in Women with Mechanical Prosthetic Heart Valves Treated with Unfractionated Heparin (UFH) or Enoxaparin. Pagnini I, Simonini G, Cavalli L, la Marca G, Iuliano A, Brandi ML, Bellisai F, Frediani B, Galeazzi M, Cantarini L, Cimaz R. Pediatr Rheumatol Online J. Like pp said. anticoagulation using heparin or low molecular weight heparin (as a bridge to warfarin) can be started as soon as 24 hours after . The good news with heparin is that it is reversible and it lasts only half the time (12 hours) as opposed to a Lovenox which lasts 24 hours. This heightened risk exists during pregnancy, delivery, and within the first three months of having a baby. According to Dr. Langon, these risks include excessive bleeding or bruising, vaginal bleeding, placental abruptionwhere the placenta pulls away from the inner wall of the uterus due to blood collection and or trauma.. Shortness of Breath and Rib Pain in Pregnancy, Everything You Need to Know About the Pfizer Vaccine, What You Need to Know About Mpox and Pregnancy. I have been on Lovenox, a blood thinner my entire pregnancy and have recently (this morning) switched to heparin now at 36 weeks till I deliver. 8600 Rockville Pike 2005-2023Everyday Health, Inc., a Ziff Davis company. Epub 2012 Jun 27. I've been on a low dose (40/day I think) of Lovenox during my pregnancy. We strive to provide you with a high quality community experience. Ageno W, Crotti S, Turpie AG. Both of my deliveries were induced at 39 weeks. 2011 Jul;31(7):678-85. doi: 10.1592/phco.31.7.678. Any updates to this document can be found on www.acog.org or by calling the ACOG Resource Center. In some cases, obstetricians, in conjunction with hematologists and maternalfetal medicine subspecialists, have transitioned pregnant women on anticoagulation from low-molecular-weight heparin (LMWH) regimens to unfractionated heparin (UFH) at or near 36 weeks of gestation. h harrisjazz18 Jan 8, 2015 at 9:46 AM @ashlfish, I was wondering if it was least painful cause I don't like having to take a shot everyday h harrisjazz18 Jan 8, 2015 at 9:49 AM @BabyAllen315, Epub 2020 Sep 5. UFH levels are monitored with activated partial thromboplastin time (aPTT) levels (goal 1.5 to 2.5 during pregnancy), while women on therapeutic LMWH are monitored with anti-Xa levels (with values of 0.6 to 1.2 being the therapeutic range). For information on new subscriptions, product Two patients experienced injection site reactions requiring discontinuation of enoxaparin. Number 276, October 2002. 2020;12(3):209-213. doi: 10.34172/jcvtr.2020.35. The site is secure. Hameed AB, Shrivastava VK, Blair L, Wing DA. Group Black's collective includes Essence, The Shade Room and Naturally Curly. Heparin is considered safe during pregnancy since it does not cross the placenta.4 Despite its inability to cross the placenta, monitoring of plasma/serum levels of therapeutic LMWH or UFH is critical, since the physiologic changes during pregnancy can affect LMWH/UFH concentrations. Dosing and monitoring of low-molecular-weight heparin in high-risk pregnancy: single-center experience. 2016 Oct;66(5):321-6. doi: 10.1007/s13224-015-0678-9. Lovenox is injected once or twice a day. LEE T. DRESANG, MD, PAT FONTAINE, MD, MS, LARRY LEEMAN, MD, MPH, AND VALERIE J. She has worked with breastfeeding parents for over a decade, and is a mom to two boys. Therefore, we performed a literature . Consider one of the subscription options below to receive full access to this article and many more. FTM, had blood clot 3 years ago but no clot disorder- docs just want to be safe! hbbd```b``` DH0d30120VU20Eg`x c I think your over thinking it. Once it was out, I got my epidural and all was fine. Anytime you take medication while pregnant, you need to make sure that its safe for yourself and for your growing baby. Dr. Langdon believes that Lovenox is effective at preventing clots during pregnancy, but says that the dose may need to be adjusted upwards for best results. By and large, the question about whether Lovenox is right for you is something you will need to discuss directly with your healthcare provider. 800-688-2421. Dont hesitate to reach out to them if you need more information, or if you have additional questions. eCollection 2014. In: FDA drug shortages: current and resolved drug shortages and discontinuations reported to FDA. In fact, their risk increases five-fold, according to the CDC. Three patients developed preeclampsia, two placenta abruptio, and one placenta previa. Lovenox (enoxaparin sodium) therapy appears to be safe and efficacious for pregnant women who are candidates for either prophylactic or therapeutic heparin. Created for people with ongoing healthcare needs but benefits everyone. This educational content is not medical or diagnostic advice. National Library of Medicine 2014 Oct 23;12:47. doi: 10.1186/1546-0096-12-47. Venous Thromboembolism (Blood Clots) and Pregnancy. V/Q scanning may be used if spiral computed tomography is unavailable. I didnt bleed any extra with either birth. Obstet Gynecol. The major problem with blood clots is that, if untreated, they can make their way to the lungs, causing a pulmonary embolism (PE), which can be life-threatening. Based on data from nonpregnant patients, PE can be excluded with a normal or low probability V/Q scan if clinical suspicion is low to moderate.25 Likewise, PE can be diagnosed with a high probability scan if clinical suspicion is moderate to high.25 In a study of V/Q scanning in 120 pregnant women with suspected PE, 73.5 percent were normal and 1.8 percent were high probability, compared with 27 to 36 percent normal and 8 to 14 percent high probability scans in nonpregnant patients.31 When V/Q scanning is nondiagnostic, additional options include repeat leg compression ultra-sonography, repeat V/Q scanning, spiral computed tomography, magnetic resonance imaging, and pulmonary angiography. Just unlucky! Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. Baxter Healthcare first reported to the U.S. Food and Drug Administration in November 2017 shortages of heparin sodium 2,000 international units/L in 0.9% weight/volume sodium chloride intravenous infusion, heparin sodium 2,000 USP units in 1,000 mL, and heparin sodium 1,000 USP units in 500 mL2. Does Lovenox Work to Prevent Blood Clots During Pregnancy? My labor was also much faster so if I had done my injection that night, they would have had to give me the reversal and I wouldnt have been able to have the epidural. Switching from Lovenox or Dalteparin to unfractionated heparin at 36 weeks Prophylactic Stop Lovenox or Dalteparin for 12 hours and begin unfractionated heparin at 10,000 u q 12 hours. Switching To and From Various Anticoagulants Xarelto. One of the most popular treatments is a prescription blood thinner called Lovenox, also known as enoxaparin. Pediatrics. KING, MD, MPH. The CDC explains that pulmonary embolisms top the list of pregnancy-related deaths in the U.S. Will I Have to Go on Bed Rest During My Twin Pregnancy? Thanks! Some women like me, know before they ever get pregnant they will have to be on anticoagulation (blood thinning) therapy, like Lovenox injections during pregnancy. Ive got HIGH anxiety about this topic and wondered if any of you have experienced pregnancy, labor and delivery on Lovenox and heparin and how it all went for you and if you were able to receive an epidural. However, the American College of Obstetricians and Gynecologists and other professional societies continue to recommend switching from LMWH to UFH, at doses of 10,000 international units of UFH, administered subcutaneously every 12 hours in the third trimester unless the aPTT is elevated, irrespective of indication (prophylactic or therapeutic use).5. [emailprotected]. For me, it was a history of a DVT, deep vein thrombosis (blood clot) in my leg. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. The optimal treatment of VTE during pregnancy has not been studied via randomized controlled trials, and clinical recommendations are based on expert opinion.10,12,24,32, Stabilization is the first priority. 0 If not, consider one of the subscription options below. Interested in Group Sales? Members of the SOAP VTE Taskforce. 8600 Rockville Pike To IV Heparin To heparin SQ Q12H To IV Bivalirudin To LMWH SQ Q24H To LMWH SQ Q12H To Fondaparinux SQ Q24h From IV heparin start IV bivalirudin at start fondaparinux . American College of Obstetricians and Gynecologists [published erratum appears in Obstet Gynecol 2018;132:1068]. Screening for thrombophilia is not recommended for the general population; however, testing for inherited or acquired thrombophilic conditions is recommended when personal or family history suggests increased risk. and transmitted securely. Please contact [emailprotected] with any questions. Anesth Analg 2018;126:928-44. Dosing and monitoring of low-molecular-weight heparin in high-risk pregnancy: single-center experience. The educational health content on What To Expect is reviewed by our medical review board and team of experts to be up-to-date and in line with the latest evidence-based medical information and accepted health guidelines, including the medically reviewed What to Expect books by Heidi Murkoff. Fertility Medicine 31 years experience. American College of Obstetricians and Gynecologists. Lovenox. Enoxaparin was safe and effective for preventing thromboembolism and adverse obstetrical complications in our patients, including 12 of 13 multiple gestation pregnancies. Hey everyone. A patient receiving injectable fertility treatment had spontaneously aborted one twin at 5 weeks' gestation. 2002;100(4):845-846. luvboston member February 2015 Your overthinking it. Ann Thorac Med. Verywell Family's content is for informational and educational purposes only. Start by selecting which of these best describes you! For example a patient with a Venous thromboembolism (blood clots) and pregnancy, ACOG Committee Opinion: safety of Lovenox in pregnancy, Venous Thromboembolism (Blood Clots) and Pregnancy, Elevated levels of serum aminotransferase, Ecchymosis (skin discoloration as a result of bleeding under the skin), Family or personal history of blood clots, Periods of prolonged immobility, including bed rest during pregnancy or after delivery, Complications during pregnancy or childbirth, Long-term medical conditions, including heart conditions, lung conditions, or diabetes. American College of Obstetricians and Gynecologists. HHS Vulnerability Disclosure, Help Pregnancy outcome in women with mechanical prosthetic heart valvesat their first trimester of pregnancy treated with unfractionated heparin (UFH) or enoxaparin: A randomized clinical trial. Of clinically suspected PE, only 4 percent are confirmed in pregnant patients, versus 30 percent in nonpregnant patients.17, Figure 1 presents an approach to the diagnosis and treatment of DVT in pregnancy derived from studies of non-pregnant patients.19,20 In nonpregnant women, a negative (low) d-dimer test combined with a low clinical probability score has a negative predictive value higher than 99.5 percent when a highly sensitive assay (e.g., enzyme-linked immunosorbent assay, latex turbidimetric assay) is used.19,20 However, d-dimer values increase progressively throughout pregnancy, and the ranges for normal values by gestational week are not yet universally established.21,22 Although a low d-dimer may be helpful in ruling out DVT, a positive (high) d-dimer result will be common during pregnancy and always requires confirmatory testing.12,20.