ABSTRACT
Changes in the coagulation system during pregnancy produce a physiological hypercoagulable state (in preparation for haemostasis following delivery). Fondaparinux is a synthetic pentasaccharide that acts through inhibition factor Xa via anti-thrombin. It is licensed in the United Kingdom for the prevention and treatment of venous thromboembolism outside pregnancy, but there is very limited experience of its use in pregnancy although it has been used in the setting of heparin intolerance. It probably crosses the placenta but no adverse effects have been reported in the fetus or newborns. Women with previous VTE should receive antenatal and post-natal thromboprophylaxis with LMWH. This should begin as early in pregnancy as possible. The Royal College of Obstetricians and Gynaecologists Green-top Guideline 37a covering thromboprophylaxis in obstetrics highlights the importance of risk assessment in early pregnancy, on admission or after development of any intercurrent illness and after delivery.
