Managing iliofemoral deep venous thrombosis of pregnancy with a strategy of thrombus removal is safe and avoids post-thrombotic morbidity

Herrera, S. R.; Comerota, Anthony J.; Thakur, Subhash; Sunderji, Shiraz; DiSalle, Robert; Kazanjian, Sahira; Assi, Zakaria

doi:10.1016/j.jvs.2013.07.108

Cited by 46 publications

(38 citation statements)

References 44 publications

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“…The fetal radiation dose resulting from PCDT in the first trimester can be calculated in the range of 175-245 mGy, which is associated with a childhood cancer risk of 1.3%-2%, six to 10 times that associated with environmental/background radiation exposure. Second-or third-trimester iliofemoral DVT might be managed by PCDT with appropriate precautions such as shielding and dose-reduction techniques, or by surgical thrombectomy (12), depending on clinical severity and early response to anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Pharmacomechanical Catheter-Directed Thrombolysis for Pregnancy-Related Iliofemoral Deep Vein Thrombosis

Bloom

Farkas

Kalish

et al. 2015

Journal of Vascular and Interventional Radiology

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Section: Discussionmentioning

confidence: 99%

Pharmacomechanical Catheter-Directed Thrombolysis for Pregnancy-Related Iliofemoral Deep Vein Thrombosis

Bloom

Farkas

Kalish

et al. 2015

Journal of Vascular and Interventional Radiology

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“…There are several options for DVT treatment: anticoagulant therapy, catheter-directed thrombolytic therapy, angioplasty and stenting (5,6). The goal of treatment is to reduce symptoms and the risk of complications.…”

Section: Discussionmentioning

confidence: 99%

“…Historically, several surgical procedures have been used to correct compression, including venovenous bypass with an autologous vein, the creation of a tissue sling to elevate the overriding right iliac artery, retropositioning of the iliac artery and excision of the intraluminal spur via patch venoplasty. Recently, an important strategy has been to provide endovascular treatment or a combination of endovascular and surgical treatment (5,6). A recent report showed that these treatments decrease the incidence of DVT, known as postthrombotic syndrome (PTS), and venous obstruction compared with systemic anticoagulation (RR =0.19, 95% CI 0.07 to 0.48) (7,8).…”

Section: Discussionmentioning

confidence: 99%

Anticoagulant Therapy in a Pregnant Woman with May-Thurner Syndrome

et al. 2016

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A 39-year-old woman with a 9-week abdominal pregnancy noted pain in her lower abdomen and left leg. Since successive thrombi were observed extending from the left common iliac vein to the popliteal vein along with a thrombus in the left pulmonary artery, we diagnosed her with pulmonary thromboembolism with deep venous thrombosis (DVT). May-Thurner syndrome may have contributed to DVT in the left leg when the left iliac vein was compressed by the right iliac artery. She underwent anticoagulant therapy with heparin, followed by the subcutaneous injection of heparin at home after discharge. We herein report the case of a pregnant woman with May-Thurner syndrome who safely gave birth.

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“…It remains unclear whether these treatment options are also a safe and eff ective alternative in pregnant women. In a case series, Herrera et al presented outcome data for 13 pregnant women with extensive DVT involving the iliofemoral veins who were treated with catheter-directed or pharmacomechanical thrombolysis (n = 11) or surgical (n = 2) venous thrombectomy [119]. After a mean follow-up of 1.3 years (range 1 -74 months), venous duplex ultrasound revealed patent veins in 12/13 patients (92 %) and normal valve functions in 10/13 patients (77 %).…”

Section: Therapeutic Options In Limb-threatening Dvtmentioning

confidence: 99%

Treatment of pregnancy-associated venous thromboembolism - position paper from the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Linnemann

Scholz

Rott

et al. 2016

Vasa

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Summary: Venous thromboembolism (VTE) is a major cause of maternal morbidity during pregnancy and the postpartum period. However, because there is a lack of adequate study data, management strategies for pregnancy-associated VTE must be deduced from observational studies and extrapolated from recommendations for non-pregnant patients. In this review, the members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH) have summarised the evidence that is currently available in the literature to provide a practical approach for treating pregnancy-associated VTE. Because heparins do not cross the placenta, weight-adjusted therapeutic-dose low molecular weight heparin (LMWH) is the anticoagulant treatment of choice in cases of acute VTE during pregnancy. No differences between once and twice daily LMWH dosing regimens have been reported, but twice daily dosing seems to be advisable, at least peripartally. It remains unclear whether determining dose adjustments according to factor Xa activities during pregnancy provides any benefi t. Management of delivery deserves attention and mainly depends on the time interval between the diagnosis of VTE and the expected delivery date. In particular, if VTE manifests at term, delivery should be attended by an experienced multidisciplinary team. In lactating women, an overlapping switch from LMWH to warfarin is possible. Anticoagulation should be continued for at least 6 weeks postpartum or for a minimum period of 3 months. Although recommendations are provided for the treatment of pregnancy-associated VTE, there is an urgent need for well-designed prospective studies that compare different management strategies and defi ne the optimal duration and intensity of anticoagulant treatment. Anticoagulant therapy during pregnancyLow-molecular-weight heparins (LMWH) are considered the anticoagulants of choice in pregnancy-associated VTE because LMWH do not cross the placenta and do not appear at signifi cant levels in breast milk. Although a Cochrane Review stated that there was no evidence from randomised controlled trials regarding the effi cacy of anticoagulant therapy for DVT in pregnancy [2], two systemic reviews of LMWH use in pregnant women have confi rmed their efficacy and safety, which were consistent with those in nonpregnant women [3,4]. Compared to unfractionated heparin (UFH), LMWH were associated with a substantially lower risk of adverse side eff ects, such as heparin-induced thrombocytopenia (HIT), haemorrhage, and osteoporosis [3 -7]. However, UFH may be considered an alternative if LMWH cannot be used or if UFH seems to be advantageous over LMWH, e.g., in women at high risk of bleeding complications or in women with severe renal impairment. Women with confi rmed PE and haemodynamic compromise who are candidates for subsequent thrombolysis should also receive UFH during the initial phase until defi nitive treatment decisions are reached [1]. Data obtained from non-pregnant patients have confi rmed that LMWH are at least as eff ective...

show abstract

Managing iliofemoral deep venous thrombosis of pregnancy with a strategy of thrombus removal is safe and avoids post-thrombotic morbidity

Abstract: Extensive DVT of pregnancy can be effectively and safely treated with a strategy of thrombus removal, resulting in a patent venous system, normal valve function in many, prevention of PTS, and reduction in recurrence.

Cited by 46 publications

References 44 publications

Pharmacomechanical Catheter-Directed Thrombolysis for Pregnancy-Related Iliofemoral Deep Vein Thrombosis

Pharmacomechanical Catheter-Directed Thrombolysis for Pregnancy-Related Iliofemoral Deep Vein Thrombosis

Anticoagulant Therapy in a Pregnant Woman with May-Thurner Syndrome

Treatment of pregnancy-associated venous thromboembolism - position paper from the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

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