Position Paper on the Management of Pregnancy-Associated Superficial Venous Thrombosis. Balkan Working Group for Prevention and Treatment of Venous Thromboembolism

Abstract

Venous thromboembolism (VTE) is a multifactorial disease that can possibly affect any part of venous circulation. The risk of VTE increases by about 2 fold in pregnant women and VTE is one of the major causes of maternal morbidity and mortality. For decades superficial vein thrombosis (SVT) has been considered as benign, self-limiting condition, primarily local event consequently being out of scope of well conducted epidemiological and clinical studies. Recently, the approach on SVT has significantly changed considering that prevalence of lower limb SVT is twice higher than both deep vein thrombosis (DVT) and pulmonary embolism (PE). The clinical severity of SVT largely depends on the localization of thrombosis, when it concerns the major superficial vein vessels of the lower limb and particularly the great saphenous vein. If untreated or inadequately treated, SVT can potentially cause DVT or PE. The purpose of this review is to discuss the complex interconnection between SVT and risk factors in pregnancy and to provide evidence-based considerations, suggestions, and recommendations for the diagnosis and treatment of this precarious and delicate clinical entity.

Zero-Fluoroscopy Catheter Ablation of Right Appendage Focal Atrial Tachycardia in a Pregnant Woman

“…Finally, the use of the “zero-fluoroscopy” technique and the help of new technologies allowed us to resolve the case without further complications for mother and fetus. The common femoral vein thrombosis that occurred after the first procedure is a possible complication expected after catheter ablation procedures using a venous approach; however, it is certain that the physiological hypercoagulable state that occurs during pregnancy facilitated this event [ 12 ]. Such a complex clinical case, burdened by two complications (intra-operative cardiac tamponade and post-operative femoral venous thrombosis), also required intensive multidisciplinary management, based on an accurate integration of both cardiological and gynecological critical issues.…”

Incidence of Pregnancy-Associated Venous Thromboembolism: Second Nationwide Study

“…2,22,23 The daily risk of VTE is 15 to 35 times higher in the postpartum period, as compared with nonpregnant women of the same age. [24][25][26] Most cases of PA-VTE occurred in the postpartum period (321/510, 62.9%). James et al reported that within pregnancy-related VTE, DVT accounts for approximately 75 to 80% of all VTE cases and 20 to 25% manifest as PE.…”

Evidence-based perioperative diagnosis and management of pulmonary embolism: A systematic review

“…Computed Tomography Pulmonary Angiography (CTPA) has greatly improved the diagnostic approach to patients with suspected PE and is considered to be the reference imaging test, but should be used, with caution in some patients, such as patients with severe renal insufficiency, those with known allergy to contrast media, and pregnant women[ [19] , [20] , [21] ]. Additionally, ECG findings include sinus tachycardia, atrial dysrhythmia, dramatic shift in R wave axis, incomplete or complete right bundle-branch block, inferolateral ST-segment elevation, or depression, inversion of T waves in leads V1–V4, and biomarkers such as elevated D-dimers or fibrin degradation are suggestive of PE [ 9 , 13 , 19 , 22 , 23 ].…”