Treatment and prophylaxis of venous thromboembolism during pregnancy.
The treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) in pregnant patients is challenging for several reasons. Coumarins can cause embryopathy and other adverse effects in the fetus. Although unfractionated heparin and low-molecular-weight heparins, the cornerstones of initial therapy, are safe for the fetus, they can have significant maternal side effects, including osteoporosis and thrombocytopenia. Because they must be given parenterally, long-term administration is inconvenient. Further, although low-molecular-weight heparins probably cause less maternal osteoporosis and thrombocytopenia than unfractionated heparin, the appropriate dosing regimens for prevention and treatment of thrombosis during pregnancy have not been established. In addition, there is a paucity of reliable information on the incidence of venous thromboembolism and the risk of recurrent thrombosis during pregnancy. This paper briefly reviews the areas of controversy and provides recommendations for the treatment and prophylaxis of acute deep vein thrombosis and pulmonary embolism in pregnant patients.
Bates
Shannon M
SM
Thromboembolism Unit Office, HSC 3W11, Department of Medicine, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5. batesm@mcmaster.ca
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D036861:Delivery, Obstetric; D005260:Female; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000517:prevention & control* / Q000628:therapy*; D011655:Pulmonary Embolism / Q000150:complications / Q000517:prevention & control / Q000628:therapy; D012449:Safety; D013923:Thromboembolism / Q000150:complications* / Q000517:prevention & control / Q000628:therapy; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000150:complications* / Q000517:prevention & control / Q000628:therapy; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D006493:Heparin