Prevention, diagnosis, and management of PE and DVT in pregnant women

Abstract

Venous thromboembolism (VTE) is a leading cause of maternal morbidity and mortality worldwide. Despite the impact of VTE on pregnant and postpartum people and on society, guidelines addressing prevention, diagnosis, and management of VTE in pregnant and postpartum people frequently are based on recommendations from expert opinion and are extrapolated from data in nonpregnant populations. Pregnant individuals are frequently excluded from clinical trials, which is a barrier to providing safe, effective care. Anchoring to a case discussion, this review provides an update on recently published and ongoing randomized clinical trials (RCTs), prospective clinical management studies, and other research in this area. It highlights, in particular, the results of the Highlow RCT, which addresses optimal prevention of recurrence during pregnancy in people with prior VTE. Finally, we raise awareness of the impact of national and international clinical trial networks on the conduct of RCTs in pregnancy. We conclude, based on these data, that academic VTE clinical trials in pregnant women can and must be done.

Evaluating Thromboprophylaxis Strategies for High-Risk Pregnancy: A Current Perspective

“…VTE represents a leading cause of death of pregnant and postpartum women. The risk of VTE is higher in the course of pregnancy when compared with the nonpregnant state and peaks in the postpartum period: pooled incidence rates are 1.2 (95% confidence interval (CI): 1.0–1.4) and 4.2 (95% CI: 2.4–7.6) per 1000 persons [ 11 ]. The pooled incidence rate for DVT is 1.1 (1.0–1.3) per 1000 patients and 0.3 (0.2–0.4) per 1000 persons for pulmonary embolism (PE) [ 12 ].…”