When should postpartum anticoagulation be started after a vaginal delivery?

Postpartum anticoagulation is an essential consideration for preventing venous thromboembolism (VTE) in women following vaginal delivery. The appropriate timing for the initiation of anticoagulation after vaginal delivery generally falls within the range of 4 to 6 hours. This timeframe allows for adequate recovery from the delivery process while minimizing the risk of thromboembolic events.

Starting anticoagulation too early can pose risks, such as bleeding complications, especially if there are any concerns related to the delivery, such as significant uterine atony or lacerations that might require additional surgical intervention. Waiting too long beyond this window also puts the patient at unnecessary risk for VTE, as the postpartum period is associated with a hypercoagulable state.

Thus, initiating postpartum anticoagulation approximately 4 to 6 hours after vaginal delivery is supported by clinical guidelines and represents a balance that maximizes benefits while minimizing risks.