Anatomic distribution of deep vein thrombosis in pregnancy

Chan, Wee‐Shian; Spencer, Frederick A.; Ginsberg, Jeffrey S.

doi:10.1503/cmaj.091692

Cited by 134 publications

(65 citation statements)

References 47 publications

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“…It has been speculated that the percent of DVTs due to MTS may be much higher than clinically recognized. This suspicion is supported by the disproportionately greater incidence of left‐sided DVT, clinical studies that report significant iliac venous compression occurs in the majority of patients with left DVT, and presence of fibrous spurs in 22% to 33% of cadavers . However, no population‐based studies have yet been conducted to document the prevalence or incidence of MTS.…”

Section: Possible Underestimation Of Contribution Of Mts To the Populmentioning

confidence: 99%

May‐Thurner syndrome: History of understanding and need for defining population prevalence

Harbin

Lutsey

2020

Journal of Thrombosis and Haemostasis

100

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Patients with May‐Thurner syndrome (MTS) are at elevated risk of developing an extensive left iliofemoral deep vein thrombosis (DVT; localized blood clot) due to an anatomical variant where the right common iliac artery compresses the left common iliac vein against the lumbar spine. While MTS was initially presumed to be rare when it was first anatomically defined in 1957, case reports of this syndrome have recently become more frequent, perhaps due to improved imaging techniques allowing for enhanced visualization of the iliac veins. Still, the population burden of this condition is unknown, and there is speculation it may be higher than generally perceived. In the present review, we (a) review history of how MTS became recognized, (b) describe practical challenges of studying MTS in population‐based settings due to the specialized imaging required for diagnosis, (c) discuss why the contribution of MTS to DVT may be underestimated, (d) describe uncertainty regarding the degree of venous compression which leads to DVT, and (e) outline future research needs. Our goal is to raise awareness of MTS and spark additional research into the epidemiology of this condition, which may be an underappreciated causative venous thromboembolism risk factor.

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Section: Possible Underestimation Of Contribution Of Mts To the Populmentioning

confidence: 99%

May‐Thurner syndrome: History of understanding and need for defining population prevalence

Harbin

Lutsey

2020

Journal of Thrombosis and Haemostasis

100

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“…However, it is also likely that differences in examination protocols (symptomatic leg vs. both legs, specifications of ultrasound protocol) may explain at least part of this variability. It is interesting to note that the anatomic distribution of DVT in pregnancy and puerperium is particular to the extent that most DVTs are left‐sided and are confined to the iliofemoral segments [3].…”

Section: Epidemiologymentioning

confidence: 99%

Isolated distal deep vein thrombosis: what we know and what we are doing

Palareti

Schellong

2012

Journal of Thrombosis and Haemostasis

118

114

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Summary. Thromboses that are restricted to the infra-popliteal deep veins of the lower limbs (isolated distal deep vein thrombosis, IDDVT) are frequently diagnosed in subjects with suspected pulmonary embolism (PE; 7-10%) or DVT (4-15%), accounting for 31-56% of all diagnosed leg DVTs. Despite their frequency, IDDVTs still remain one of the most debated issues in the field of venous thromboembolism (VTE). Conflicting clinical results have resulted in differing opinions on the need to test for IDDVTs and how to treat them. Due to discordant results, the real risk of IDDVT-associated PE is not well established. IDDVTs are associated with (i) lower risk of recurrence when compared with other VTEs, and (ii) fewer late sequelae than proximal DVT. Diagnosis of IDDVT is based on ultrasound examination of all calf veins, which is more operator-dependent and less sensitive than proximal vein examination. A series of studies has shown, however, that a single complete ultrasound strategy in symptomatic patients has comparable clinical results to serial proximal ultrasound, allowing approximately 15% better DVT diagnosis. Optimal treatment of IDDVT is still controversial. Guidelines recommend anticoagulation for 12 weeks, although 6 weeks may be sufficient. There is, however, insufficient data to support the diagnosis and treatment of all IDDVTs, and the necessary criteria to identify subjects at higher risk of complication are lacking. It also seems likely that different approaches may be better for unprovoked or secondary events and for deep or muscle veins. Specifically designed and adequately powered clinical studies addressing the issue of IDDVT need to be urgently undertaken.

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“…10,11 Between 75% and 90% of pregnancy-related DVTs are left-sided (vs 55% in the nonpregnant patient), 12 likely due to May-Thurner syndrome caused by compression from the gravid uterus. Additionally, almost 70% of DVTs in pregnancy occur proximally in the iliofemoral veins (vs 9% in nonpregnant patients), 13 and , 10% of DVTs in pregnancy are isolated calf DVTs. Proximal DVTs lead to an increased risk of subsequent PE versus more distal clots.…”

Section: Risk Factors For Venous Thromboembolism Physiologic and Anatmentioning

confidence: 99%

Diagnosis, Treatment, and Prevention of Venous Thromboembolism in Pregnancy

Marshall

2014

Postgraduate Medicine

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Pregnancy and the puerperium put women at increased risk of venous thromboembolism (VTE) due to both baseline maternal risk factors and the development of pregnancy-related prothrombotic anatomic and physiologic changes. Pregnant women are at an approximately 5-fold increased risk of VTE compared with nonpregnant women, and the risk of VTE increases further (to ≥ 20-fold) in puerperium; risk remains increased until approximately 12 weeks postpartum. Pregnancy-related VTE accounts for about 10% of maternal deaths in the developed world. Clinicians should promptly evaluate any signs or symptoms suspicious for VTE, generally starting with ultrasound of the lower extremities. For treatment of women with established VTE, low molecular weight heparins (LMWHs) are preferred due to a favorable safety and efficacy profile. Unfractionated heparin (UFH) and potentially fondaparinux are alternatives. Warfarin should be avoided in the antepartum period due to teratogenicity, and the non-vitamin K oral anticoagulants are currently not recommended due to the lack of data. Low molecular weight heparin, UFH, and warfarin are all acceptable in the postpartum period and for breast-feeding women, but the non-vitamin K oral anticoagulants should be avoided. Prophylaxis (generally with LMWH or in some cases UFH) is recommended for women at highest risk of pregnancy-related VTE, such as those with inherited thrombophilias and a strong family or personal history of VTE. Prophylaxis with LMWH and aspirin is recommended for women with antiphospholipid syndrome. Clinicians should engage in multidisciplinary discussion, particularly around the time of delivery, to manage the details of anticoagulation in their pregnant patients.

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Anatomic distribution of deep vein thrombosis in pregnancy

Cited by 134 publications

References 47 publications

May‐Thurner syndrome: History of understanding and need for defining population prevalence

May‐Thurner syndrome: History of understanding and need for defining population prevalence

Isolated distal deep vein thrombosis: what we know and what we are doing

Diagnosis, Treatment, and Prevention of Venous Thromboembolism in Pregnancy

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