Deep venous thrombosis in pregnancy: incidence, pathogenesis and endovascular management

Abstract

Deep venous thrombosis (DVT) during pregnancy is associated with high mortality, morbidity, and costs. Pulmonary embolism (PE), its most feared complication, is the leading cause of maternal death in the developed world. DVT can also result in long-term complications that include postthrombotic syndrome (PTS) adding to its morbidity. Women are up to 5 times more likely to develop DVT when pregnant. The current standard of care for this condition is anticoagulation. This review discusses the epidemiology, pathogenesis, prophylaxis and diagnosis of DVT during pregnancy, and then focuses on endovascular treatment modalities. Inferior vena cava (IVC) filter placement and pharmacomechanical catheter directed thrombolysis (PCDT) in the pregnant patient are discussed, as well as patient selection criteria, and complications.

Gestational diabetes mellitus is associated with antenatal hypercoagulability and secondary hyperfibrinolysis: a case control study of Chinese women

“…Nevertheless, in developed nations, the leading cause of maternal death is thromboembolic disease [19][20][21] . Thrombotic events during pregnancy, including maternal DVT(deep venous thrombosis) and pregnancy-related cerebral venous sinus thrombosis, are responsible for increasing levels of maternal mortality worldwide [22,23] . Previous studies have shown that this hypercoagulability is exacerbated in pregnant women with GDM [4,24,25] and that there is a significantly higher frequency of DVT in pregnant women with type 1 diabetes mellitus [26] .…”

“…During the analysis, the data were anonymized, and therefore the requirement for informed consent was waived. To avoid recruitment bias, we collected consecutive data from all pregnant women awaiting delivery, but not yet in labor, in the Obstetrics department of our hospital from 23 October to 23 November 2018. After the exclusion of 18 individuals for the reasons given below, 182 women were included in the analysis, who were classified as having GDM or not having GDM (the GDM group and the NGDM group).…”

Association between venous thromboembolism and acute pancreatitis: An analysis from the nationwide inpatient sample

“…8,9 Previous studies have reported that diabetes, hypertension, cerebral vascular disease (CVA), heart failure, cancers, pregnancy, lower leg fracture and major surgery are associated with risk of VTE. [10][11][12][13][14] Prophylactic anticoagulants for reducing the risk of VTE may be considered for acutely ill patients. 15 However, a discrepancy has been observed between the incidence rates of VTE reported in Taiwan and in Western countries.…”

“…Deep vein thrombosis (DVT) and pulmonary embolism (PE) constitute VTE, which remains a major contributor to 30‐day and 1‐year case fatality rates . Previous studies have reported that diabetes, hypertension, cerebral vascular disease (CVA), heart failure, cancers, pregnancy, lower leg fracture and major surgery are associated with risk of VTE . Prophylactic anticoagulants for reducing the risk of VTE may be considered for acutely ill patients .…”

Therapeutic heparin during the peripartum period

“…It is thought that the physiological changes in pregnancy induce a prothrombotic environment which increases the risk of thrombosis (4)(5)(6). In addition, certain patient populations are already at increased risk of thrombosis including those with mechanical heart valves (MHVs) and previous VTE (7).…”