How I treat pregnancy-related venous thromboembolism

Blood. 2011 Nov 17;118(20):5394-400. doi: 10.1182/blood-2011-04-306589. Epub 2011 Sep 14.

Abstract

Venous thromboembolism (VTE) complicates ~ 1 to 2 of 1000 pregnancies, with pulmonary embolism being a leading cause of maternal mortality and deep vein thrombosis an important cause of maternal morbidity, also on the long term. However, a strong evidence base for the management of pregnancy-related VTE is missing. Management is not standardized between physicians, centers, and countries. The management of pregnancy-related VTE is based on extrapolation from the nonpregnant population, and clinical trial data for the optimal treatment are not available. Low-molecular-weight heparin (LMWH) in therapeutic doses is the treatment of choice during pregnancy, and anticoagulation (LMWH or vitamin K antagonists postpartum) should be continued until 6 weeks after delivery with a minimum total duration of 3 months. Use of LMWH or vitamin K antagonists does not preclude breastfeeding. Whether dosing should be based on weight or anti-Xa levels is unknown, and practices differ between centers. Management of delivery, including the type of anesthesia if deemed necessary, requires a multidisciplinary approach, and several options are possible, depending on local preferences and patient-specific conditions.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anticoagulants / therapeutic use*
  • Delivery, Obstetric
  • Female
  • Heparin, Low-Molecular-Weight / therapeutic use*
  • Humans
  • Infant, Newborn
  • Postpartum Period
  • Pregnancy
  • Pregnancy Complications, Hematologic / diagnosis
  • Pregnancy Complications, Hematologic / drug therapy*
  • Pregnancy Outcome*
  • Venous Thromboembolism / diagnosis
  • Venous Thromboembolism / drug therapy*
  • Vitamin K / antagonists & inhibitors

Substances

  • Anticoagulants
  • Heparin, Low-Molecular-Weight
  • Vitamin K