Column Introduction:

The medical field is evolving rapidly. Precise and authoritative clinical guidelines not only signal changes in diagnostic and treatment standards but also influence global medication choices.

HepaVanguard is a newly established content column by Hepalink Pharmaceutical, focusing on global guideline updates, research progress, and market approval dynamics for heparin-based drugs. We are committed to tracking information at its source and distilling key insights to present—in a clear and readable manner—the real-world advancements of heparin in the global therapeutic landscape.

We invite you to follow this column as we explore the logic behind guideline evolution, grasp the frontier consensus on medication choices, and expand the boundaries of our understanding of heparin's clinical value.

Shortly after giving birth, a woman suddenly experienced severe headaches and vomiting, followed by clouded consciousness. Initially dismissed by her family as postpartum fatigue, she was later diagnosed at the hospital with Cerebral Venous Thrombosis (CVT)—a relatively under-recognized condition posing a significant threat to maternal health.

While the overall incidence of CVT is lower than other forms of thrombosis, it is significantly more prevalsent, insidious, and prone to misdiagnosis during pregnancy and the puerperium. In severe cases, it can be life-threatening.

The recently released "Guidelines for the management of Cerebral Venous Thrombosis during Pregnancy and the Puerperium (2025 Edition)" was jointly developed by the Expert Committee of the Million Disability Reduction Project of the National Health Commission, the Cerebral Venous Diseases Branch of the China Stroke Association, and the Stroke Prevention and Control Professional Committee of the Chinese Preventive Medicine Association. This guideline aims to provide a more scientific and systematic clinical reference for diagnosis and treatment.

This article summarizes three core insights from the guidelines:

• Why pregnancy and the puerperium are high-risk stages for CVT.
• Scientific prevention and the selection of safe medications.
• Management and precautions for women with a history of CVT regarding future pregnancies.

Why Pregnancy and the Puerperium are High-Risk Stages for CVT

The guidelines emphasize that physiological changes and alterations in the internal environment during pregnancy and the puerperium significantly increase the risk of CVT. These women represent a key population requiring heightened clinical vigilance.

Scientific Prevention: Focus Groups

The guidelines recommend incorporating CVT into routine risk assessment systems during pregnancy and the puerperium to ensure early identification and intervention. Particular attention should be paid to the following groups:

• Pregnant or postpartum women with a history of CVT or other thrombophilia.
• Individuals with abnormal blood components caused by Protein C/S deficiency or Antiphospholipid Syndrome (APS).
• Those with other high-risk factors such as Cesarean section, Assisted Reproductive Technology (ART), or advanced maternal age.

For high-risk or very high-risk individuals, clinicians may consider the prophylactic use of Low Molecular Weight Heparin (LMWH) during pregnancy. Coagulation function and platelet counts should be monitored regularly to prevent risks such as bleeding. Additionally, women with a history of CVT should exercise caution regarding oral contraceptives to reduce the risk of recurrence.

Treatment Selection: Safe Anticoagulation During Pregnancy

Anticoagulation is the core measure for CVT treatment. The guidelines explicitly state that pregnancy and the puerperium are not contraindications for anticoagulation; treatment should be initiated as soon as CVT is confirmed.

Recommended Medication Strategies:

• During Pregnancy: LMWH is the preferred choice as it does not cross the placenta and possesses a high safety profile.
• During Lactation: LMWH or Warfarin are options, as they have limited impact on breast milk.
• Currently Not Recommended:
  Vitamin K Antagonists (VKA, e.g., Warfarin) are not recommended during pregnancy due to their ability to cross the placental barrier and potential teratogenic risks.
  Direct Oral Anticoagulants (DOACs) are not recommended due to a lack of safety evidence in pregnant or lactating populations.

Anticoagulation Management Around Delivery:

• Discontinue LMWH at least 24 hours before natural labor, planned induction, or Cesarean section.
• Switch to Unfractionated Heparin (UFH) 36 hours before induction or Cesarean section, and discontinue UFH 4–6 hours prior to the procedure.
• Anticoagulation should resume as soon as possible after delivery: within 6–12 hours after natural labor and within 12–24 hours after a Cesarean section.

Can Women with a History of CVT Conceive Again?

This is likely the question of greatest concern to many patients. The guidelines clearly state that CVT is not a contraindication to subsequent pregnancies, but must be undertaken under professional assessment and management.

Key Recommendations:

• Pre-pregnancy Assessment: At least 3–6 months before attempting to conceive, patients should undergo venous imaging—such as CT Venography (CTV), Magnetic Resonance Venography (MRV), or Magnetic Resonance Black-Blood Thrombus Imaging (MRBTI)—to evalsuate vascular recovery.
• Consultation: Seek advice from a multidisciplinary team to assess risks before proceeding with pregnancy.
• During Pregnancy: Low-dose LMWH is recommended throughout pregnancy and up to 6 weeks postpartum to reduce the risk of recurrence.
• Vigilance: If CVT-like symptoms occur, immediate medical consultation is required to rule out recurrence.

A scientific assessment and management plan can effectively mitigate the risk of recurrence, making pregnancy for patients with a prior history more controlled and secure.

Conclusion

Cerebral Venous Thrombosis during pregnancy and the puerperium presents high risks and management complexity. The 2025 guidelines provide robust medical support for identifying high-risk individuals and implementing long-term management, reflecting the value of evidence-based medicine in maternal and infant safety.

Whether for identification, medication, or recurrence prevention, the core principle remains: Scientific Assessment + Individualized Anticoagulation + Multidisciplinary Collaboration.

LMWH continues to be one of the most recommended and safe anticoagulation options for patients during pregnancy and the puerperium.

As a global leader in the heparin industry, Hepalink remains committed to following international therapeutic consensuses, providing high-quality products, professional insights, and timely information to serve the safety of patients worldwide.

Reference:

Guidelines for the management of Cerebral Venous Thrombosis during Pregnancy and the Puerperium (2025 Edition), Chinese Medical Journal, 2025, Vol. 105, No. 39, 3518–3540.