Anticoagulant therapy for venous thromboembolism during pregnancy: a systematic review and a meta-analysis of the literature: a reply to a rebuttal

Romualdi, Chiara; Dentali, Francesco; Squizzato, Alessandro; Ageno, Walter

doi:10.1111/jth.12163

Cited by 6 publications

(2 citation statements)

References 10 publications

(8 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Venous thromboembolism (VTE) complicates 2 of 1000 deliveries 1 and is a major contributor to maternal morbidity and mortality. 2,3 Pregnant women are 5 times more likely to develop VTE than nonpregnant women, with the highest risk during the third trimester and postpartum period. 1,4 Although catheter-directed thrombolysis (CDT) has been established as a safe and effective treatment for VTE in nonpregnant patients, pregnant patients were excluded from these trials.…”

Section: Introductionmentioning

confidence: 99%

Thrombolysis for Venous Thromboembolism During Pregnancy: A Literature Review

Dua

Lavingia

et al. 2018

Vasc Endovascular Surg

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Thrombolysis for Venous Thromboembolism During Pregnancy: A Literature Review

Dua

Lavingia

et al. 2018

Vasc Endovascular Surg

View full text Add to dashboard Cite

show abstract

“…The European Society of Cardiology has recommended the initiation of thrombolysis when high-risk patients present with hemodynamic instability, in its 2014 acute pulmonary embolism treatment guidelines. [ 3 ] Although there is growing evidence that heparin is a safe anticoagulant to administer during pregnancy, [ 4 , 5 ] there have been no conclusive guidelines for the use of thrombolytic agents during the hemodynamic instability period of pregnancy. Adaptations with respect to the monitoring of thrombolytic agents may, therefore, require further investigation.…”

Section: Introductionmentioning

confidence: 99%

Successful low-dosage thrombolysis of massive pulmonary embolism in primigravida

et al. 2018

View full text Add to dashboard Cite

Rational:Thrombolysis in primigravida with hemodynamic instability is controversial, especially treatment with low-dosage recombinant tissue plasminogen activator (rtPA), and related studies are extremely rare. Here, we report the case of a 26-year-old primigravida diagnosed with an acute massive pulmonary embolism (PE) that prompted initiation of thrombolysis with low-dose alteplase.Patient concerns:The patient was admitted to the Emergency Department with chief complaints of a sudden onset of extremely dyspnea, chest tightness, and confusion over a 6-hour period. She was found to have significant dilation of her right ventricle, moderate pulmonary arterial hypotension, as shown by transthoracic echocardiography, and a typical S1-Q3-T3 pattern, as shown by electrocardiogram (ECG).Diagnosis:Acute massive PE in primigravida.Intervention:The patient underwent intravenous thrombolysis with a half dose of alteplase.Outcomes:The fetus lived through this severe event during the mother's stay in the Intensive Care Unit; however, surgical abortion was unexpectedly proposed due to long-term hypoxia and high-risk of relapse and exacerbation and was performed successfully after the agreement of her kin. The patient recovered gradually, and results of her laboratory tests and postsurgical, repeated contrast-enhanced computed tomography had normalized by her 3-month follow-up.Lessons:Administration of low-dosage alteplase in primigravida with hemodynamic instability is extremely rare and controversial; however, our case suggests that this treatment strategy is relatively safe and feasible. In addition, nonradiometric examination played a major role in the diagnosis of PE in this patient. Because radiation use is contraindicated during pregnancy, these examinations could be the first choice for pregnant patients with suspected PE.

show abstract