Risk factors for pregnancy-associated venous thromboembolism: a review

Kevane, Barry; Donnelly, Jennifer; D’Alton, Mary E.; Cooley, Sharon; Preston, Roger J. S.; Ainle, Fionnuala B Ní

doi:10.1515/jpm-2013-0207

Cited by 41 publications

(36 citation statements)

References 52 publications

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“…Within the current published evidence base, preeclampsia has been consistently identified as a risk factor for pregnancyassociated VTE [11][12][13][14][15][16][17]. Our understanding of the magnitude of VTE risk associated with this disease continues to evolve as the evidence base in this area expands [10]. In particular, the impact of preeclampsia on VTE risk at different stages of pregnancy and postpartum has been characterized in greater detail in recent years with the publication of a number of large retrospective cohort and case control studies.…”

Section: Clinical Vte Risk In Preeclampsiamentioning

confidence: 99%

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Elevated venous thromboembolism risk in preeclampsia: molecular mechanisms and clinical impact

Egan

Kevane

Áinle

2015

Biochemical Society Transactions

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Venous thromboembolism (VTE) remains a leading cause of maternal death and morbidity in the developed world. Strategies for prevention of VTE in pregnancy have been the subject of recent guidelines and consensus statements. These guidelines recommend thrombosis prevention in women who have risk factors associated with an elevated VTE risk. Preeclampsia is characterized by maternal hypertension and proteinuria developing after 20 weeks gestation, complicating up to 7% of pregnancies and is associated with a massive annual morbidity and mortality burden. Women with preeclampsia have been shown to be at increased risk of VTE with studies to date suggesting that this risk may be up to 5-fold greater than the risk of pregnancy-associated VTE in the general population. Despite the fact that preeclampsia is so common and potentially devastating, our understanding of its pathogenesis and potential therapeutic strategies remain poor. In addition, the mechanisms underlying the prothrombotic phenotype in preeclampsia are also poorly characterized although a number of potential mechanisms have been postulated. Derangements of platelet and endothelial activation and impairment of endogenous anti-coagulant pathways have been reported and may contribute to the observed VTE risk. Recently, evidence for the role of neutrophil extracellular traps (NETs) and cell-free DNA in the pathogenesis of VTE has emerged and some evidence exists to suggest that this may be of relevance in preeclampsia. Future studies aimed at understanding the diagnostic and potential therapeutic relevance of this procoagulant state are likely to be of enormous clinical benefit for pregnant women affected with this potentially devastating condition.

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Section: Clinical Vte Risk In Preeclampsiamentioning

confidence: 99%

“…Moreover, plasma levels of trophoblast (placenta)-derived, tissue factor (TF)-expressing microparticles are significantly elevated in patients with preeclampsia [9]. However, as we have recently described, the precise mechanisms underlying the preeclampsia-associated prothrombotic phenotype remain incompletely understood [10].…”

Section: Introductionmentioning

confidence: 99%

Elevated venous thromboembolism risk in preeclampsia: molecular mechanisms and clinical impact

Egan

Kevane

Áinle

2015

Biochemical Society Transactions

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“…In a recent systematic review and meta‐analysis restricted to recent studies in which VTE cases were validated, the pooled incidence rate of VTE during the antepartum period was 118 (95% CI, 101‐137) per 100 000 person‐years and 424 (95% CI, 238‐755) per 100 000 person‐years during the postpartum period . Mechanisms underlying this pregnancy‐related increase in VTE risk include venous stasis, pelvic venous compression by the gravid uterus, pulsatile compression of the left iliac vein by the right iliac artery and changes in pro‐ and anticoagulant and fibrinolytic pathways . For example, plasma endogenous thrombin potential and plasminogen activator inhibitor‐1 levels are significantly higher in pregnant women compared with nonpregnant controls …”

Section: Introductionmentioning

confidence: 99%

“…include venous stasis, pelvic venous compression by the gravid uterus, pulsatile compression of the left iliac vein by the right iliac artery and changes in pro-and anticoagulant and fibrinolytic pathways. [5][6][7][8] For example, plasma endogenous thrombin potential and plasminogen activator inhibitor-1 levels are significantly higher in pregnant women compared with nonpregnant controls. 7,8 In pregnancy, platelets undergo morphological changes and their activation is increased.…”

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confidence: 99%

VTE risk assessment in pregnancy

Ewins

Áinle

2020

Research and Practice in Thrombosis and Haemostasis

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A State of the Art lecture, “VTE Risk Assessment in Pregnancy,” was presented at the ISTH congress in Melbourne, Australia, in 2019. Venous thromboembolism (VTE) remains a leading cause of death in pregnancy and in the postpartum period. Moreover, VTE can result in lifelong disability. The elevated baseline pregnancy‐associated VTE risk is further increased by additional maternal, pregnancy, and delivery characteristics, highlighting the importance of VTE risk assessment in early pregnancy, at delivery, and if risk factors change. This review will provide an overview of the impact and epidemiology of VTE in pregnancy (including reported risk factors for pregnancy‐associated VTE), will address VTE risk‐reduction strategies (including ongoing studies), and will provide a summary of critical knowledge gaps. Finally, throughout this review, relevant new data presented during the 2019 ISTH annual congress in Melbourne will be summarized.

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“…With the increase in the rates of obesity in women of reproductive age in Poland, focused guidance is needed to support both parturients and practitioners throughout pregnancy and postnatally. As such, the current review, focuses on the role of obesity as a leading risk factor for VTE, and readers are directed to other published works for discussion of other VTE-related risk factors, including thrombophilia and history of prior events [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Venous thromboembolism in obese pregnant women: approach to diagnosis and management

et al. 2017

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Venous thromboembolism (VTE) remains among the leading causes of maternal mortality in the developed world, presenting variably as deep vein thrombosis (DVT), pulmonary embolism (PE) or cerebral vein thrombosis (CVT), among others. Obesity in particular has been recognized as the principal contributing factor to the risk of VTE in pregnancy and with the global increase in the rates of obesity affecting reproductive age women, heightened awareness of the risk and consequences of VTE in this population are vital. Thus, prophylaxis, diagnosis and treatment of VTE in the obese gravida are discussed.

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Risk factors for pregnancy-associated venous thromboembolism: a review

Cited by 41 publications

References 52 publications

Elevated venous thromboembolism risk in preeclampsia: molecular mechanisms and clinical impact

Elevated venous thromboembolism risk in preeclampsia: molecular mechanisms and clinical impact

VTE risk assessment in pregnancy

Venous thromboembolism in obese pregnant women: approach to diagnosis and management

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