Management of venous thromboembolism in pregnancy

Abstract

Venous thromboembolism (VTE) in pregnancy, consisting of deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major factor of maternal mortality. Several patient-specific risk factors along with the physiologic changes of pregnancy promote a state of hypercoagulability in pregnant women. Detailed assessment of all pregnant women can establish a risk profile that would guide clinical decisions, and balance potential therapeutic benefits with side effects. Differentiating between physiologic changes of pregnancy and symptoms of VTE can be challenging and warrants meticulous clinical evaluation. Timely and accurate diagnosis of VTE with proper imaging is essential for its management, and systemic anticoagulation remains the cornerstone of VTE prevention and therapy. Furthermore, advanced invasive treatment options such as inferior vena cava filters and thrombectomy can be considered for complex cases. Importantly, the risk of systemic anticoagulation should be balanced against the risk of VTE-associated morbidity and mortality for mother and fetus, and an informed decision should be made. In this review, we present an up-to-date overview of VTE management in pregnancy and the postpartum period.

Safety and Efficacy of Endovascular Treatment on Pregnancy-Related Iliofemoral Deep Vein Thrombosis

“…Moreover, IVC filter should be retrieved later to avoid filter complications including migration, deformation, fracture, failed retrieval and filter occlusion. 9,[22][23][24][25]44 In the present study, except for 5 patients with IVC filters placed due to a history of VTE, filter retrieval was successful in the other patients. The filter removal interval was slightly lower in the PCDT group but not statistically significant.…”

“…Anticoagulation therapy is an important standard treatment for DVT because it prevents new clot formation and reduces the risk of recurrent venous thromboembolism, but it cannot lyse the thrombus. 9 , 22 – 25 Even with long-term anticoagulation therapy, 20%-50% of patients developed PTS after DVT, with 5%-10% developing severe PTS. 3 , 26 The incidence of PTS is relatively high in pregnancy-related DVT.…”

“…Lactating women were recommended warfarin for anticoagulation therapy, whereas lactation was not recommended for postpartum patients taking new oral anticoagulants. 22 , 23 …”

Inferior vena cava filters in pregnancy: Safe or sorry?

“…The incidence of other filter complications is lower and similar to incidence rates of the nonpregnant population. Some authors suspected that during the second stage of labor and delivery intra-abdominal pressure could cause tilt, fracture and migration of the filter ( 20 , 75 ). Due to the low number of patients in our review, we were unable to statistically compare such complications for patients with vaginal delivery compared to patient who had a caesarean section.…”

Uso de anticoagulante no ciclo gravídico-puerperal e os efeitos adversos relacionados: revisão de literatura

“…A tríade de Virchow é formada pelo estado de hipercoagulabilidade, estase venosa e lesão endotelial, sendo que o ciclo gravídico-puerperal está associado ao desenvolvimento de um estado de hipercoagubilidade com aumentos fisiológicos dos fatores de coagulação desde a concepção até o parto, pois a hipercoagulação é uma adaptação do organismo materno as demandas hemostáticas, com a finalidade de proteção contra sangramentos excessivos durante o processo do parto, ao mesmo tempo que visam a hemostasia após o parto, interferindo o tempo de protrombina e no tempo de tromboplastina parcial (Kalaizopoulos et al, 2022) (Mendonça et al, 2021).…”