Evidence Base for the Management of Venous Thromboembolism in Pregnancy

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 173-180 ◽  
Author(s):  
Marc Rodger
Keyword(s):  
Venous Thromboembolism ◽  
Signs And Symptoms ◽  
Bleeding Risk ◽  
Evidence Base ◽  
Vein Thrombosis ◽  
Absolute Benefit ◽  
Diagnostic Approaches ◽  
Pharmacologic Thromboprophylaxis ◽  
Deep Vein ◽  
In Pregnancy

Abstract Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of maternal mortality during pregnancy. DVT and PE are commonly suspected due to many mimicking signs and symptoms that are normal in pregnancy. However, validated diagnostic approaches are lacking, and a fear of teratogenic/oncogenic exposure from imaging procedures affects the acceptability of diagnostic approaches used for VTE during pregnancy. DVT and PE treatment in pregnancy is also challenging due to this lack of validated diagnostic approaches, changes in maternal physiology, and the need for intact hemostasis at the time of delivery/epidural analgesia. Prevention requires an optimal balancing of absolute increased bleeding risk from pharmacologic thromboprophylaxis and the absolute benefit of reduced DVT and PE, which, while serious, are relatively uncommon.

PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM IN HIGH RISK SITUATIONS IN PREGNANCY

2005 ◽  
Vol 16 (1) ◽  
pp. 51-70 ◽  
Author(s):  
ANNE G McLEOD ◽  
CAMERON ELLIS
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Pregnant Women ◽  
Signs And Symptoms ◽  
Multiple Gestation ◽  
Vein Thrombosis ◽  
Low Threshold ◽  
Deep Vein ◽  
In Pregnancy

Venous thromboembolism (VTE) is a leading cause of maternal mortality in the western developed world. VTE may present as deep vein thrombosis (DVT) or pulmonary embolism (PE) but if untreated can result in fatal PE. Although fatal PE is clearly the most significant consequence of VTE in pregnancy, DVT also often leads to morbidity related to the development of post-thrombotic syndrome (PTS). Pregnancy is an independent risk factor for VTE and the risk of VTE is 4–10 fold higher in pregnant women than in non-pregnant women of similar age. The puerperium represents a time of even higher risk. It is clear that many additional high-risk situations in pregnancy lower the threshold for thrombosis and warrant measures to prevent VTE and its complications. Risk factors for pregnancy-related VTE may be inherited or acquired. Acquired risk factors may be specifically related to the pregnancy or may have developed prior to pregnancy. Well-documented risk factors for pregnancy-related VTE include delivery by Caesarean section, previous VTE, and inherited or acquired thrombophilia. Other risk factors that have been identified include obesity, multiparity, multiple gestation, pre-eclampsia and medical conditions, such as sickle cell disease, that predispose to VTE. Our ability to diagnose VTE overall is poor as presenting signs and symptoms are extremely varied and unreliable. This is further complicated in pregnancy where signs and symptoms suggestive of VTE are common and invasive testing is more complicated. It is essential that physicians be vigilant in monitoring patients for the development of VTE and maintain a low threshold for considering thromboprophylaxis. Guidelines have recently been published by several medical societies to help with these difficult decisions. In this review the risk factors for the development of VTE in pregnancy will be discussed and guidelines for risk assessment presented. Management of patients who develop VTE in pregnancy is also outlined.

Venous Thromboembolism

2020 ◽  
Author(s):  
Samuel Z. Goldhaber
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Antithrombotic Agents ◽  
Vein Thrombosis ◽  
Recurrent Venous Thrombosis ◽  
Deep Vein ◽  
D Dimer ◽  
In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites).  This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

scholarly journals How I treat pregnancy-related venous thromboembolism

Blood ◽  
2011 ◽  
Vol 118 (20) ◽  
pp. 5394-5400 ◽  
Author(s):  
Saskia Middeldorp
Keyword(s):  
Venous Thromboembolism ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Total Duration ◽  
Clinical Trial Data ◽  
Evidence Base ◽  
Patient Specific ◽  
Vein Thrombosis ◽  
Therapeutic Doses ◽  
Deep Vein

Abstract Venous thromboembolism (VTE) complicates ∼ 1 to 2 of 1000 pregnancies, with pulmonary embolism being a leading cause of maternal mortality and deep vein thrombosis an important cause of maternal morbidity, also on the long term. However, a strong evidence base for the management of pregnancy-related VTE is missing. Management is not standardized between physicians, centers, and countries. The management of pregnancy-related VTE is based on extrapolation from the nonpregnant population, and clinical trial data for the optimal treatment are not available. Low-molecular-weight heparin (LMWH) in therapeutic doses is the treatment of choice during pregnancy, and anticoagulation (LMWH or vitamin K antagonists postpartum) should be continued until 6 weeks after delivery with a minimum total duration of 3 months. Use of LMWH or vitamin K antagonists does not preclude breastfeeding. Whether dosing should be based on weight or anti-Xa levels is unknown, and practices differ between centers. Management of delivery, including the type of anesthesia if deemed necessary, requires a multidisciplinary approach, and several options are possible, depending on local preferences and patient-specific conditions.

scholarly journals A comparison of aspirin against rivaroxaban for venous thromboembolism prophylaxis after hip or knee arthroplasty: A meta-analysis

2020 ◽  
Vol 28 (1) ◽  
pp. 230949901989602
Author(s):  
Joshua Xu ◽  
Aran Kanagaratnam ◽  
Jacob Y Cao ◽  
Gurpreet S Chaggar ◽  
Warwick Bruce
Keyword(s):  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Cost Effective ◽  
Bleeding Risk ◽  
Wound Complications ◽  
Significant Heterogeneity ◽  
Thromboembolism Prophylaxis ◽  
Vein Thrombosis ◽  
Deep Vein

Purpose: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients are at an elevated risk of post-operative venous thromboembolism (VTE). Newer thromboprophylactic agents such as rivaroxaban are increasingly used and effective in preventing thromboembolic events but may worsen bleeding risk. Recent studies have suggested that the more cost-effective aspirin may also be effective in preventing VTE. This systematic review and meta-analysis aimed to compare the efficacy of aspirin against rivaroxaban for the prevention of VTE following TKA and THA. Methods: Electronic searches were performed using five databases from their date of inception to August 2018. Relevant studies were identified, with data extracted and meta-analyzed from the studies. Results: Five studies were included, which consisted of 2257 in the aspirin group and 2337 in the rivaroxaban group. There were no differences between aspirin and rivaroxaban for either VTE ( p = 0.48) or its components deep vein thrombosis ( p = 0.44) and pulmonary embolism ( p = 0.98). Also, there were no differences between groups for either major bleeding ( p = 0.17), any bleeding ( p = 0.62), readmissions ( p = 0.37) or wound complications ( p = 0.17). Conclusion: Aspirin was not significantly different to rivaroxaban for prevention of VTE or adverse events after TKA or THA. However, this study was limited by the significant heterogeneity of the included studies. More large randomized studies are needed to add to this body of evidence.

Venous Thromboembolism

2020 ◽  
Author(s):  
Samuel Z. Goldhaber
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Antithrombotic Agents ◽  
Vein Thrombosis ◽  
Recurrent Venous Thrombosis ◽  
Deep Vein ◽  
D Dimer ◽  
In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites).  This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

Venous Thromboembolism

2020 ◽  
Author(s):  
Samuel Z. Goldhaber
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Antithrombotic Agents ◽  
Vein Thrombosis ◽  
Recurrent Venous Thrombosis ◽  
Deep Vein ◽  
D Dimer ◽  
In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites).  This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

scholarly journals Strategies for Diagnosis and Prevention of Venous Thromboembolism during Pregnancy

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Shalini Jain Bagaria ◽  
V. B. Bagaria
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Adverse Effects ◽  
Risk Stratification ◽  
Postpartum Period ◽  
Vein Thrombosis ◽  
Altered Physiology ◽  
Deep Vein ◽  
In Pregnancy

Pregnancy and the postpartum period have an increased incidence of venous thromboembolism (VTE). The condition is unique during this period for several reasons. Primarily, because there is complexity in diagnosing this condition in view of altered physiology and preexisting edema in pregnancy and also because there are restrictions on the use of certain drugs and a need for vigilant monitoring of anticoagulant activities of drugs during the period. The problem is compounded and assumes the highest order of significance since two lives are involved and all the investigations and management done should also take into account the potential adverse effects on the foetus. In order to prevent the development of VTE during pregnancy, sound clinical evaluation for risk factors, risk stratification, and optimal use of resource both mechanical and pharmacological is necessary. This paper details strategies in preventing development of deep vein thrombosis and treatment of VTEs.

Thrombosis in pregnancy

2020 ◽  
pp. 2606-2612
Author(s):  
Peter K. MacCallum ◽  
Louise Bowles
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Scoring Systems ◽  
Fold Increase ◽  
Normal Pregnancy ◽  
Vein Thrombosis ◽  
Clinical Scoring ◽  
Pregnant State ◽  
Deep Vein ◽  
In Pregnancy

Pregnancy and the puerperium are associated with a 10-fold increase in the risk of venous thromboembolism, comprising deep vein thrombosis and pulmonary embolism, compared to the non-pregnant state. Pulmonary embolism has been the leading direct cause of maternal mortality in most of the United Kingdom’s triennial Confidential Enquiries into Maternal Deaths over the past 30 years, attesting to the importance of prevention and prompt diagnosis and treatment of venous thromboembolism during pregnancy and following delivery. The diagnosis of venous thromboembolism is challenging in pregnancy because it can be difficult to distinguish features of venous thromboembolism, such as leg swelling and breathlessness, from those of normal pregnancy, and there are no validated clinical scoring systems. All women should undergo risk assessment for venous thromboembolism in early pregnancy, at the time of hospital admission or change in clinical condition, and after delivery.

scholarly journals Clinical significance of recurrent venous thromboembolism

2010 ◽  
Vol 9 (2) ◽  
pp. 72-75 ◽  
Author(s):  
Nicos Labropoulos ◽  
Georgios Spentzouris ◽  
Marcone Lima Sobreira
Keyword(s):  
Quality Of Life ◽  
Venous Thromboembolism ◽  
Financial Burden ◽  
Signs And Symptoms ◽  
High Impact ◽  
Accurate Diagnosis ◽  
Vein Thrombosis ◽  
Recurrent Venous Thromboembolism ◽  
Deep Vein

Recurrent venous thromboembolism is a significant problem leading to increased morbidity and mortality. It has a high impact on patients' quality of life and imposes a great financial burden on society. Cumulative recurrence has been reported as 40% at 10 years, while the chance of developing postthrombotic signs and symptoms in the lower extremities almost quadruples when ipsilateral. There is also a higher chance of developing pulmonary hypertension. Important factors for recurrence are unprovoked episodes of deep vein thrombosis, malignancy and older age. The evidence for other factors is controversial. Accurate diagnosis and treatment tailored to the patients' history, thrombotic events and risk factors are necessary to optimize management and prevent recurrence.

Venous Thromboembolism

2020 ◽  
Author(s):  
Samuel Z. Goldhaber
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Antithrombotic Agents ◽  
Vein Thrombosis ◽  
Recurrent Venous Thrombosis ◽  
Deep Vein ◽  
D Dimer ◽  
In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites).  This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

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