International registry of pregnancy during NOAC use

Before filling out this CRF, please contact Marjolein Brekelmans or Suzanne Bleker for detailed instructions.

1. Name of investigator: *This question is required.

2. Email address *This question is required. This question requires a valid email address.

3. Study Number *This question is required.

Center Code
Patient Code

4. Date (dd/mm/yyyy): *This question is required. This question requires a valid date format of DD/MM/YYYY.

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5. Case previously published elsewhere? *This question is required.

Pregnancy and NOAC Use

6. Estimated last day of last menstrual period (dd/mm/yyyy): *This question is required. This question requires a valid date format of DD/MM/YYYY.

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7. Estimated date of delivery (dd/mm/yyyy): *This question is required. This question requires a valid date format of DD/MM/YYYY.

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8. Delivery date (dd/mm/yyyy): *This question is required. This question requires a valid date format of DD/MM/YYYY.

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9. NOAC use: *This question is required.

10. Indication for NOAC: *This question is required.

11. Dose of NOAC (mg): *This question is required. This question requires a valid number format.

International registry of pregnancy during NOAC use – Inclusion