scholarly journals Prevention and management of venous thromboembolism in pregnancy: cutting through the practice variation

Hematology ◽  
2021 ◽  
Vol 2021 (1) ◽  
pp. 559-569
Author(s):  
Leslie Skeith
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Practice Variation ◽  
Limited Data ◽  
Anticoagulation Management ◽  
Inherited Thrombophilia ◽  
Related Data ◽  
Level Monitoring ◽  
In Pregnancy

Abstract There is clinical practice variation in the area of prevention and management of venous thromboembolism (VTE) in pregnancy. There are limited data and differing recommendations across major clinical practice guidelines, especially relating to the role of postpartum low-molecular-weight heparin (LMWH) for patients with mild inherited thrombophilia and those with pregnancy-related VTE risk factors. This chapter explores the issues of practice variation and related data for postpartum VTE prevention. Controversial topics of VTE management in pregnancy are also reviewed and include LMWH dosing and the role of anti-Xa level monitoring, as well as peripartum anticoagulation management around labor and delivery.

Venous Thromboembolism: Genetics and Thrombophilias

2021 ◽  
Vol 42 (02) ◽  
pp. 271-283
Author(s):  
Manila Gaddh ◽  
Rachel P. Rosovsky
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Family History ◽  
Morbidity And Mortality ◽  
Inherited Thrombophilia ◽  
Risks And Benefits ◽  
Hereditary Thrombophilia ◽  
The World ◽  
The Future ◽  
History Of

AbstractVenous thromboembolism (VTE) is a major cause of morbidity and mortality throughout the world. Up to one half of patients who present with VTE will have an underlying thrombophilic defect. This knowledge has led to a widespread practice of testing for such defects in patients who develop VTE. However, identifying a hereditary thrombophilia by itself does not necessarily change outcomes or dictate therapy. Furthermore, family history of VTE by itself can increase an asymptomatic person's VTE risk several-fold, independent of detecting a known inherited thrombophilia. In this article, we will describe the current validated hereditary thrombophilias including their history, prevalence, and association with VTE. With a focus on evaluating both risks and benefits of testing, we will also explore the controversies of why, who, and when to test as well as discuss contemporary societal guidelines. Lastly, we will share how these tests have been integrated into clinical practice and how to best utilize them in the future.

Pulmonary Complications of Pregnancy: Venous Thromboembolism

2017 ◽  
Vol 38 (02) ◽  
pp. 135-147 ◽  
Author(s):  
Leslie Skeith ◽  
Marc Rodger
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Diagnostic Imaging ◽  
Drug Exposure ◽  
Imaging Techniques ◽  
Treatment Algorithm ◽  
Pregnant Patient ◽  
Pulmonary Complications ◽  
Anticoagulation Management ◽  
In Pregnancy

AbstractUnique considerations are needed when diagnosing and treating venous thromboembolism (VTE) in women who are pregnant or postpartum. What are the risks to the fetus, such as drug exposure or the risk of radiation with diagnostic imaging? How does the physiology of pregnancy affect imaging techniques and anticoagulation management? How should anticoagulation be managed around labor and delivery? These questions highlight some of the important considerations needed when managing a pregnant patient with suspected or confirmed VTE. This review outlines what is known about the epidemiology, pathophysiology, clinical risk factors, diagnosis, and therapeutic management of VTE in pregnancy. We also review our preferred diagnostic and treatment algorithm for a pregnant patient with suspected or confirmed VTE.

Evaluating the Role of Clinical Practice Guidelines for Diabetes in Pregnancy: A Survey of Specialist Physicians

2014 ◽  
Vol 38 (5) ◽  
pp. S55
Author(s):  
Danielle Stringer ◽  
Leigh Minuk ◽  
Laura Kerr ◽  
Rachelle Govia ◽  
Maureen Heaman ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Diabetes In Pregnancy ◽  
In Pregnancy

scholarly journals Updates in Diagnosis and Management of Preeclampsia in Women with CKD

2020 ◽  
Vol 15 (9) ◽  
pp. 1371-1380 ◽  
Author(s):  
Kate Wiles ◽  
Lucy C. Chappell ◽  
Liz Lightstone ◽  
Kate Bramham
Keyword(s):  
Kidney Function ◽  
Kidney Biopsy ◽  
Clinical Use ◽  
Limited Data ◽  
Abnormal Placentation ◽  
Diagnosis And Management ◽  
Treatment Targets ◽  
Angiogenic Markers ◽  
In Pregnancy

It is estimated that women with CKD are ten times more likely to develop preeclampsia than women without CKD, with preeclampsia affecting up to 40% of pregnancies in women with CKD. However, the shared phenotype of hypertension, proteinuria, and impaired excretory kidney function complicates the diagnosis of superimposed preeclampsia in women with CKD who have hypertension and/or proteinuria that predates pregnancy. This article outlines the diagnoses of preeclampsia and superimposed preeclampsia. It discusses the pathogenesis of preeclampsia, including abnormal placentation and angiogenic dysfunction. The clinical use of angiogenic markers as diagnostic adjuncts for women with suspected preeclampsia is described, and the limited data on the use of these markers in women with CKD are presented. The role of kidney biopsy in pregnancy is examined. The management of preeclampsia is outlined, including important advances and controversies in aspirin prophylaxis, BP treatment targets, and the timing of delivery.

The role of hypovitaminosis D in pregnancy-related venous thromboembolism

2012 ◽  
Vol 67 (1) ◽  
pp. 97-97 ◽  
Author(s):  
L. Mascitelli ◽  
W. B. Grant ◽  
M. R. Goldstein
Keyword(s):  
Venous Thromboembolism ◽  
Hypovitaminosis D ◽  
In Pregnancy

scholarly journals Role of Porcine Base Anticoagulant During Pregnancy and Puerperium as Prophylaxis Treatment in Venous Thromboembolism (VTE): Shariah Views and Perspectives

2019 ◽  
Vol 8 (2S11) ◽  
pp. 567-574
Keyword(s):  
Venous Thromboembolism ◽  
Preventive Treatment ◽  
Medical Practitioners ◽  
Vte Prophylaxis ◽  
Life Threatening ◽  
New Perspective ◽  
Physiological Changes In Pregnancy ◽  
Textual Content ◽  
In Pregnancy

Physiological changes in pregnancy makes the pregnancy a hypercoagulable state. Recent Malaysian maternal mortality enquiry in 2016-2017 statistic revealed that the principal cause of maternal death is caused by venous thromboembolism (VTE) particularly pulmonary Embolism (PE). Low Molecular Weight Heparin (LMWH) is the treatment of choice in pregnancy due to its efficacy, effectiveness and safety profile which is superior then other anticoagulants. Unfortunately, LMWH is porcine base anticoagulant which creates a huge hesitancy and dilemma amongst Muslim medical practitioners. Perplexity especially in preventive treatment as the national fatwa issued permissible usage only in life threatening necessity. The objective of this study is to evaluate the principals in shariah towards mothers at risk of VTE during pregnancy and puerperium whom will be prescribed porcine base anticoagulant as prophylaxis. Utilizing textual content analysis in this qualitative research, the outcome will clarify the feasibility by al-zikr or ahl al-khibrah in porcine based medication as VTE prophylaxis treatment. This study aimed to purpose a new perspective in delineating the dilemma among Muslim practitioner.

The angiotensin-converting enzyme insertion/deletion polymorphism and serum levels of angiotensin-converting enzyme in venous thromboembolism

2007 ◽  
Vol 98 (10) ◽  
pp. 777-782 ◽  
Author(s):  
Cihan Ay ◽  
Peter Bencur ◽  
Rainer Vormittag ◽  
Thomas Sailer ◽  
Christof Jungbauer ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Angiotensin Converting Enzyme ◽  
Total Population ◽  
Serum Levels ◽  
Converting Enzyme ◽  
Limited Data ◽  
Genotype Frequencies ◽  
Risk Patients ◽  
Ace Genotype

SummaryThe angiotensin-converting enzyme (ACE) has been suggested to affect blood coagulation and fibrinolysis. Results from literature on the role of the frequent insertion/deletion (I/D) polymorphism in the ACE gene in venous thromboembolism (VTE) are controversial. Only limited data on ACE serum levels in VTE exist. We determined the ACE I/D polymorphism by genotyping and ACE serum levels by an enzymatic assay in 100 high-risk patients with objectively confirmed recurrent VTE and at least one event of an unprovoked deep venous thrombosis or pulmonary embolism. One hundred twenty-five age- and sex-matched healthy individuals served as controls. ACE genotype frequencies were not significantly different between patients (DD: 26.0%,ID: 52.0%, II: 22.0%) and controls (DD: 29.6%, ID: 44.8%, II: 25.6%; p=0.56). Neither individuals with ACE DD genotype nor those with ACE ID genotype had a higher risk for VTE in comparison to those with ACE II genotype (odds ratio and [95% confidence interval]: 1.0 [0.5–2.1] and 1.4 [0.7–2.6], respectively). Serum ACE levels (U/l) did not differ between patients (median = 25.25, 25th –75th percentile: 20.20–33.70) and controls (24.20, 17.85–34.50, p=0.49). In the total population involved in the study the ACE DD genotype (n=63: 36.00 [26.40–43.00]) was associated with higher ACE levels than the ACE ID genotype (n=108: 24.10 [19.80–31.48], p<0.001) and the ACE II genotype (n=54: 19.35 [15.00–22.95], p<0.001). In conclusion, we found a significant association of the ACE I/D polymorphism with ACE serum levels. However, neither the serum levels nor the I/D genotype were associated with VTE.

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