Pregnancy and preconception advice warfarin or DOACs

Borders Ref Help Toolkit
NHS Borders

Please note the two referral routes depending on whether the woman is pregnant or planning to conceive.

For pregnant women, this advice refers to those needing ongoing anticoagulation: warfarin & VKAs, low molecular weight heparin, fondaparinux, direct oral anticoagulants (DOACs).

  • Pregnant: see below – requires urgent or semi-urgent referral. Please note that the haematology on call consultant should be phoned for advice about pregnant women on oral anticoagulants as outlined below.
  • Preconception: patients should be referred to the Department of Haematology at RIE for counselling. For patients on long-term warfarin or other anticoagulants, please seek initial advice from the clinician managing the patient’s underlying condition, but also refer to the haematology clinic.

Who to refer, who not to refer, how to refer

Who to refer:

URGENT: Pregnant and on warfarin, VKA or direct oral anticoagulant (DOAC): telephone haematology consultant on call at RIE directly for advice, and involve locality consultant obstetrician

SEMI-URGENT: Pregnant and on therapeutic low molecular weight heparin or fondaparinux – please send urgent referral to haematology / obstetric clinic in RIE or SJH

How to refer:

Preconception: via Sci Gateway to Department of Haematology at RIE

Pregnant and on warfarin, VKA or DOAC: phone haematology consultant on call via RIE

Pregnant and on therapeutic LMWH or fondaparinux: send letter to Department of Haematology RIE  

Primary care management

Primary care investigations

  • Clinical history and documentation of results of imaging are most important

Editorial Information

Last reviewed: 19/02/2025

Next review date: 19/02/2027

Author(s): Charlotte Robertson.