Evaluation of Complications in Postpartum Women Receiving Therapeutic Anticoagulation

Côté-Poirier, G.; Bettache, N.; Côté, Anne‐Marie; Mahone, Michèle; Morin, Francine; Cumyn, Annabelle; Bureau, Yves-André; Malick, Mandy; Sauvé, Nadine

doi:10.1097/aog.0000000000003971

Cited by 8 publications

(24 citation statements)

References 13 publications

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“…The characteristics of included studies can be found in Table 1 . Four retrospective cohort 8 , 9 , 10 , 18 and one prospective cohort studies 19 were included, representing a total of 1487 participants (611 receiving therapeutic‐dose anticoagulation and 876 controls). Therapeutic‐dose anticoagulation was administered with LMWH or unfractionated heparin.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies included control groups of pregnant women without acute VTE who were not receiving anticoagulation, 8 , 9 while the remaining studies had no control group. 10 , 18 , 19 The bleeding definitions used in individual studies were variable. Two studies used the ISTH major bleeding definition, which includes fatal bleeding and/or bleeding in a critical area or organ, and/or bleeding causing a fall in hemoglobin level of 20 g/L or leading to an intravenous transfusion of two or more units of whole blood or red cells.…”

Section: Resultsmentioning

confidence: 99%

“… 6 , 7 While LMWH is considered safe in pregnancy, variable estimates are reported in the literature pertaining to the risk of bleeding with the use of therapeutic anticoagulation for VTE in pregnancy. 8 , 9 , 10 Postpartum hemorrhage (PPH) is the leading direct cause of maternal death worldwide. 11 As such, understanding the risk of bleeding for women on therapeutic anticoagulation is paramount to inform clinical care and anticipate the health care needs of this complex population.…”

Section: Introductionmentioning

confidence: 99%

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Bleeding in women with venous thromboembolism during pregnancy: A systematic review of the literature

Simard

Gerstein

Cafaro

et al. 2022

Research and Practice in Thrombosis and Haemostasis

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Objectives Venous thromboembolism (VTE) represents an important cause of maternal morbidity and mortality. Estimates of bleeding associated with therapeutic‐dose anticoagulation are variable. We describe the frequency of bleeding in pregnant women receiving therapeutic anticoagulation for VTE by means of a systematic review of the literature. Data Sources Medical Literature Analysis and Retrieval System, Embase, Scopus, Web of Science, and ClinicalTrials.gov were searched. Databases were searched from inception to February 27, 2022. There was no language or geographic location restriction. Methods of Study Selection The search yielded 2773 articles with 2212 unique citations. Studies were included if they described pregnant women treated for an acute VTE with therapeutic‐dose anticoagulation and a defined bleeding outcome was reported. Tabulation, Integration, and Results Five studies met inclusion criteria. Included studies were judged to have a serious to critical risk of bias using the Risk of Bias in Nonrandomized Studies of Intervention tool. The rate of bleeding, as defined by respective studies, ranged between 2.9% and 30.0%. Two studies included control groups, one of which found no significant difference in the risk of bleeding between groups, while the other found a significantly increased bleeding risk associated with therapeutic anticoagulation. Conclusion Among pregnant women anticoagulated for VTE, the reported bleeding risk is variable. The ability to draw definite conclusions is limited by the scarcity and low quality of the studies, the small number of included patients, and the heterogeneity of bleeding definitions used. Large‐scale studies with standardized bleeding definitions are required to provide acute bleeding estimates and optimize the care of these patients. Systematic Review Registration PROSPERO, CRD42021276771.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bleeding in women with venous thromboembolism during pregnancy: A systematic review of the literature

Simard

Gerstein

Cafaro

et al. 2022

Research and Practice in Thrombosis and Haemostasis

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“…Initiating ther a peu tic-dose LMWH too soon may lead to a seri ous post op er a tive bleed ing com pli ca tion in which the patient may be off of anticoagulation for longer, which could then increase the risk of VTE. In a ret ro spec tive cohort study of 232 con sec u tive women on ther a peu tic anticoagulation who deliv ered in Que bec, Canada, between 2003 and 2015, resum ing ther a peu tic anticoagulation within approx i ma tely 15 hours 68 after CD and approximately 9 hours within vag i nal deliv ery was associ ated with a higher risk of a com pos ite of major hem or rhagic com pli ca tions (requir ing trans fu sion, hos pi tal i za tion, vol ume resus ci ta tion, trans fer to an inten sive care unit, or sur gery) and major wound com pli ca tions. Starting with a pro phy lac tic-dose LMWH post de liv ery or delaying ther a peu tic anticoagulation for lon ger appears safer.…”

Section: Table 3 (Continued)mentioning

confidence: 99%

Prevention and management of venous thromboembolism in pregnancy: cutting through the practice variation

Skeith

2021

Hematology

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There is clinical practice variation in the area of prevention and management of venous thromboembolism (VTE) in pregnancy. There are limited data and differing recommendations across major clinical practice guidelines, especially relating to the role of postpartum low-molecular-weight heparin (LMWH) for patients with mild inherited thrombophilia and those with pregnancy-related VTE risk factors. This chapter explores the issues of practice variation and related data for postpartum VTE prevention. Controversial topics of VTE management in pregnancy are also reviewed and include LMWH dosing and the role of anti-Xa level monitoring, as well as peripartum anticoagulation management around labor and delivery.

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“…Another complication to be considered is iatrogenic postoperative bleeding. The risk of bleeding with prophylactic doses are usually mild, such as wound hematomas, and rarely life-threatening hemorrhagic complications [16][17][18][19][20][21]. In cases with significant intraoperative bleeding complications, the decision of when to start pharmacologic prophylaxis (if indicated) must be individualized according with the clinical and surgical scenarios [2,3,21].…”

Section: Considerations For Vte Prophylaxis In Cesarean Sectionmentioning

confidence: 99%

VTE Prophylaxis in Cesarean Section

Péret¹,

Paula²

2021

Current Topics in Caesarean Section

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Venous thromboembolism (VT is a major cause of maternal mortality and severe morbidity. Pharmacological and non-pharmacological methods of prophylaxis are therefore often used for women considered to be a risk including women who have given birth by cesarean section. The risk is potentially increased in women with a personal or family history of VTE, women with genetic or acquired thrombophilia, and another risk factors like sickle cell disease, inflammatory bowel disease, active cancer, obesity, preeclampsia·and SARS COVID 19 infection. However, a specific score in obstetrics has not yet been well defined. Recommendations from major society guidelines for post-cesarean section (C/S) thromboprophylaxis differ greatly; the safety and efficacy of drug prophylaxis - mainly low molecular weight heparins - has been demonstrated, but large scale randomized trials of currently-used interventions should be conducted. The purpose of this chapter is to discuss the indications and contraindications for VTE prophylaxis in cesarean sections, prophylaxis regimens and potential adverse events.

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Evaluation of Complications in Postpartum Women Receiving Therapeutic Anticoagulation

Abstract: A, et al. Evaluation of complications in postpartum women receiving therapeutic anticoagulation. Obstet Gynecol 2020;136. The authors provided this information as a supplement to their article.

Cited by 8 publications

References 13 publications

Bleeding in women with venous thromboembolism during pregnancy: A systematic review of the literature

Bleeding in women with venous thromboembolism during pregnancy: A systematic review of the literature

Prevention and management of venous thromboembolism in pregnancy: cutting through the practice variation

VTE Prophylaxis in Cesarean Section

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