Anticoagulant therapy for deep vein thrombosis (DVT) in pregnancy

Abstract

Background Thromboembolic complications are much higher in pregnancy due to procoagulant changes. Heparin does not cross the placenta and the use of unfractionated heparin (UFH) is the current established practice in prophylaxis and treatment for thromboembolism in pregnancy. Objectives To compare the effectiveness of anticoagulant therapies for the treatment of deep vein thrombosis in pregnancy. The anticoagulant drugs included are UFH, low molecular weight heparin (LMWH) and warfarin. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (March 2010) and reference lists of retrieved studies. Selection criteria Randomised controlled trials comparing any combination of warfarin, UFH, LMWH and placebo in pregnant women. Data collection and analysis We used methods described in the Cochrane Handbooks for Systemic Reviews of Interventions for assessing the eligibility of studies identified by the search strategy. A minimum of two review authors independently assessed each study. Main results We did not identify any eligible studies for inclusion in the review. We identified three potential studies; after assessing eligibility, we excluded all three as they did not meet the prespecified inclusion criteria. One study compared LMWH and UFH in pregnant women with previous thromboembolic events and, for most of these women, anticoagulants were used as thromboprophylaxis. There were only three women who had a thromboembolic event during the current pregnancy and it was unclear whether the anticoagulant was used as therapy or prophylaxis. We excluded one study because it included only women undergoing caesarean birth. The third study was not a randomised trial. Authors’ conclusions There is no evidence from randomised controlled trials on the effectiveness of anticoagulation for deep vein thrombosis in pregnancy. Further studies are required.

Anticoagulant therapy for venous thromboembolism during pregnancy: a systematic review and a meta‐analysis of the literature

“…[3,6,8,9]. Although a few systematic and narrative reviews have tried to assess the risk–benefit profile of anticoagulant treatment of VTE in pregnancy [3,9–11], these studies have often mixed together data from patients receiving anticoagulant therapy for different indications, such as VTE treatment or prophylaxis, prevention of obstetric complications, and prevention of arterial thrombosis in patients with mechanical cardiac valves, or, conversely, have focused on only a single therapeutic agent.…”

The effect of low molecular weight heparin combined with air pressure in the prevention of lower extremity venous thrombosis after cesarean section: A single-center retrospective study

“…The enlarged uterus also compresses the iliac and inferior vena cava, resulting in blood stasis and venous thrombosis of the lower limbs. [ 25 ] Almost all coagulation factors increas to varying degrees during the middle of the pregnancy, and peak at the time of delivery. [ 26 ] Post-operatively, patients are usually advised bed-rest for 24 hours.…”

Treatment of pregnancy-associated venous thromboembolism - position paper from the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

“…Although a Cochrane Review stated that there was no evidence from randomised controlled trials regarding the effi cacy of anticoagulant therapy for DVT in pregnancy [2], two systemic reviews of LMWH use in pregnant women have confi rmed their efficacy and safety, which were consistent with those in nonpregnant women [3,4]. Compared to unfractionated heparin (UFH), LMWH were associated with a substantially lower risk of adverse side eff ects, such as heparin-induced thrombocytopenia (HIT), haemorrhage, and osteoporosis [3 -7].…”