Obstetrics and Gynecology Clinics of North America
VENOUS THROMBOEMBOLISM AND PREGNANCY
Section snippets
Unfractionated Heparin
Unfractionated heparin has been the mainstay of treatment for acute VTE events and for thromboprophylaxis during pregnancy. Although widely studied in nonpregnant patients, there are insufficient prospective controlled studies in pregnant women to offer conclusive statements about either efficacy or optimal dosing of unfractionated heparin. Recommendations regarding the use of unfractionated heparin in the treatment of acute VTE or in thromboprophylaxis are extrapolated from studies in
SUMMARY
Venous thromboembolism remains a major cause of maternal morbidity and mortality. Pregnancy is a thrombogenic state; therefore, clinicians must be familiar with the diagnosis and treatment of acute VTE. It is of paramount importance when caring for pregnant women to understand which patients are at risk for VTE and to use thromboprophylactic heparin accordingly.
References (91)
- et al.
Thrombophlebitis associated with pregnancy
Acta Obstet Gynecol Scand
(1971) - et al.
A prospective study of heparin-induced osteoporosis in pregnancy using bone densitometry
Am J Obstet Gynecol
(1994) - et al.
Heparin levels to guide thromboprophylaxis during pregnancy
Am J Obstet Gynecol
(1995) Venous thromboembolism and pregnancy
Clin Obstet Gynecol
(1981)- et al.
The relationship between the hemorrhagic and thrombotic properties of low molecular weight heparin in rabbits
Blood
(1982) - et al.
Changes in the pharmacokinetics of the low-molecular-weight heparin enoxaparin sodium during pregnancy
Am J Obstet Gynecol
(1999) - et al.
Pharmacologic profile of a low-molecular weight heparin (reviparin) in pregnant patients: A prospective cohort study
Thromb Res
(2000) - et al.
Bone mineral density during long-term prophylaxis with heparin in pregnancy
Am J Obstet Gynecol
(1994) Osteoporotic fractures and the recurrence of thromboembolism during pregnancy and the puerperium in 184 women undergoing thromboprophylaxis with heparin
Am J Obstet Gynecol
(1993)Maternal mortality: Confidential inquiries into maternal deaths in the United Kingdom
Am J Obstet Gynecol
(2000)
Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy
Obstet Gynecol
Use of antithrombotic agents during pregnancy
Chest
Antiphospholipid antibodies and thrombosis
Lancet
Thrombosis in pregnancy: Maternal and fetal issues
Lancet
Heparin and low-molecular-weight heparin: Mechanisms of action, pharmacokinetics, dosing considerations, monitoring, efficacy and safety
Chest
Low-molecular-weight heparin for obstetric thromboprophylaxis: Experience of sixty-nine pregnancies in sixty-one women at risk
Am J Obstet Gynecol
Thromboprophylaxis with low molecular weight heparin (dalteparin) in pregnancy
Thromb Res
The effects of low molecular weight heparin on calcium loss from fetal calvaria
Blood
Anticardiolipin antibodies: Clinical consequences of low titers
Obstet Gynecol
Low-molecular weight heparins and unfractionated heparin in the treatment of patients with acute venous thromboembolism: Results of a meta-analysis
Am J Med
Magnetic resonance imaging of deep venous thrombosis in pregnant women with lower extremity edema
Obstet Gynecol
Clinical characteristics of patients with acute pulmonary embolism
Am J Cardiol
Postpartum pulmonary embolus as an unusual cause of cortical blindness
Am J Obstet Gynecol
Recurrent thromboembolism in pregnancy and puerperium: Is there a need for thromboprophylaxis?
Am J Obstet Gynecol
Recommendations for Neuraxial Anesthesia and Anticoagulation
Maternal and perinatal mortality
Curr Opin Obstet Gynecol
Recurrence of venous thromboembolic disease and oral contraceptives
BMJ
Pregnancy-related mortality in the United States, 1987–1990
Obstet Gynecol
Acute deep venous thrombosis (DVT) after cesarean section
Acta Obstet Gynecol Scand
Deep venous thrombosis during pregnancy: A prospective study
Acta Obstet Gynecol Scand
Pregnancy and venous thromboembolism
Acta Obstet Gynecol Scand
Outcome of treated pregnancies in women with antiphospholipid syndrome: An update of the Utah experience
Obstet Gynecol
Gestational outcome in thrombophilic women with recurrent pregnancy loss treated by enoxaparin
Thromb Haemost
Safety of withholding heparin in pregnant women with a history of venous thromboembolism
N Engl J Med
Prospective evaluation of bone density in pregnant women receiving the low molecular weight heparin enoxaparin sodium
J Matern Fetal Med
Anticoagulation of pregnant women with mechanical heart valves: A systematic review of the literature
Arch Intern Med
Contemporary venous imaging
Cardiovasc Intervent Radiol
A standard heparin normogram for the management of heparin therapy
Arch Intern Med
Comparing subcutaneous danaparoid with intravenous unfractionated heparin for the treatment of venous thromboembolism: A randomized controlled trial
Ann Intern Med
Confidential Enquiries into Maternal Deaths in the United Kingdom, 1994–1997
Antenatal use of enoxaparin for prevention and treatment of thromboembolism in pregnancy
Br J Obstet Gynaecol
Low molecular weight heparin (CY 216) does not cross the placenta during the third trimester of pregnancy
Thromb Haemost
Obstetrical pulmonary embolism mortality, United States, 1970–1985
Am J Public Health
Increased intravascular coagulation associated with pregnancy
Obstet Gynecol
Cited by (27)
Gender Issues in Venous Thromboembolism
2010, Principles of Gender-Specific MedicineAntithrombotic therapy and pregnancy: consensus report and recommendations for prevention and treatment of venous thromboembolism and adverse pregnancy outcomes
2007, American Journal of Obstetrics and GynecologyCitation Excerpt :Typically, patients at highest risk are on coumarin before pregnancy and ideally should be converted to LMWH before conception or as soon as the patient presents for care. Previous guidelines have recommended that target peak anti-Xa levels (measured 4 hours after a subcutaneous dose) should be 1.0-1.2 IU/mL.5 Therapeutic anticoagulation should be considered in high-risk women during pregnancy but using prophylactic dosing and less frequent monitoring than in the highest-risk group.
Venous Thromboembolism: Gender Effects and Gender-Specific Risk Factors for Women
2004, Principles of Gender-Specific MedicineCardiac arrest during pregnancy
2005, Journal of Clinical AnesthesiaThe Obstetric Patient
2005, Primary Care for the Physical TherapistPulmonary embolism: An unsuspected killer
2004, Emergency Medicine Clinics of North AmericaCitation Excerpt :If pulmonary angiography is required, the abdomen can be shielded in an attempt to reduce radiation exposure to the fetus. If PE is discovered, warfarin is contraindicated because it is a known teratogen [71], and the patient requires admission and daily administration of unfractionated heparin or low-molecular-weight heparin for the duration of pregnancy. Elderly patients are at an increased risk of developing PE, but it is unclear if this is because age is an independent risk factor or secondary to a higher prevalence of underlying disease and recent surgery in this patient population.
Address reprint requests to Robert L. Andres, MD, University of Texas-Houston Medical School, Division of Maternal-Fetal Medicine, 6431 Fannin, Suite 3.270, Houston, Texas 77030