Risks to the Fetus of Radiologic Procedures Used in the Diagnosis of Maternal Venous Thromboembolic Disease

Ginsberg, Jeffrey S.; Hirsh, Jack; Rainbow, Andrew J.; Coates, Geoffrey

doi:10.1055/s-0038-1646557

Cited by 189 publications

(110 citation statements)

References 37 publications

(47 reference statements)

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“…The association of thrombotic cerebral events and inherited thrombophilia is still controversial. Several studies have reported that patients with prothrombin or FV Leiden mutations are at higher risk of developing cerebral vein thrombosis [151,154,187]. However, other studies have failed to show a significant link between thrombophilia and the occurrence of cerebral venous or arterial thrombosis [1,145,146,152,[154][155][156]188] No studies have described the association between thrombophilia and cerebral ischemic events during pregnancy.…”

Section: Arterial Thrombosis During Pregnancymentioning

confidence: 93%

“…The resistance can also be acquired during the second and third trimester of a normal pregnancy as a result of increases in FV and factor VIII and decreased protein S levels [1,155,148,157]. The precise mechanism for this "physiological" APCR is still not known, nor its contribution to the higher risk of VTE during pregnancy [1,154,148,158]. The prothrombin mutation is associated with elevated plasma prothrombin levels (factor II activity >130 percent) and is present in about 2-5 percent of healthy individuals.…”

Section: Hereditary Thrombophilias and Venous Thrombosis During Pregnmentioning

confidence: 99%

“…Emergency cesarean section is associated with the highest risk, and maternal age and weight are also important predictive factors [153]. A high proportion of both post-partum DVT and pulmonary embolism manifests after discharge from hospital [154], highlighting the need for careful surveillance in the puerperium [155].…”

Section: Venous Thromboembolism (Vte) In Pregnancymentioning

confidence: 99%

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Thrombophilia and pregnancy

Brenner¹

2005

Eur J Clin Investigation

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Pregnancy is hypercoagulable state. The field of thrombophilia; the tendency to thrombosis, has been developed rapidly and has been linked to many aspects of pregnancy. It is recently that severe pregnancy complications such as severe preeclampsia intrauterine growth retardation abruptio placentae and stillbirth has been shown to be associated with thrombophilia. Recurrent miscarriage and has also been associated with thrombophilia. Finally, thromboembolism in pregnancy as in the non-pregnant state is linked to thrombophilia. In this review all aspects of thrombophilia in pregnancy are discussed, and also all prophylactic and therapeutic implications.Thrombophilias are inherited or acquired conditions which predispose an individual to thromboembolism. Deficiencies of protein S C and antithrombin are rare and each of them is found in about 3% of patients with thrombosis. Recently, three important inherited thrombophilias were discovered which are responsible of the majority of thromboembolic events in patients with otherwise no apparent risk for thrombosis. Resistance to activated protein C caused by an adenine 506 guanine (A506G) mutation in factor V (factor V Leiden) has been linked with an increased risk for venous thromboembolism [1][2][3]. Heterozygosity for the factor V (FV) Leiden mutation is found in about 5% of the population and the mutation is responsible of 20-30% of venous thromboembolism events. A recently described guanine 20210 adenine mutation in prothrombin is associated with higher plasma prothrombin concentrations and increased risk for venous thromboembolism [4] and cerebral-vein thrombosis [5]. Homozygosity for the cytosine 677 thymine (C677T) mutation in methylenetetrahydrofolate reductase (MTHFR) results in decreased synthesis of 5-methyltetrahydrofolate, the primary methyl donor in the conversion of homocysteine to methionine and the resulting increase in plasma homocysteine concentrations is a risk factor for thrombosis [6,7]. The mutation is responsible for reduced MTHFR activity and is the most frequent cause of mild hyperhomocysteinemia and can be found in 5-15% of the population.Homocysteine is an independent risk factor for atherosclerosis, stroke, peripheral vascular disease and cardiovascular diseases [8,9]. Homocysteine concentrations are affected by nutrition. A deficiency in folate, B-6, and/or B-I2 causes elevation of homocysteine. Homocysteine concentrations are also affected by genetics such as cystathionine beta-synthase deficiency (10) and C677T MTHFR gene mutation [7]. Hyperhomocysteinemia promotes vascular damage by several mechanisms. Many of the endothelial vascular changes associated with hyperhomocysteinemia can be found in preeclampsia [11][12][13][14][15]. thrombophilia is substantially increased. The risk of VTE in pregnant women may be further amplified by the type of underlying genetic predisposition, like, homozygosity for a mutation, the presence of multiple mutations (multigenic defects) or thrombophilic anomalies [16][17][18][19].Thrombophilia and ad...

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Section: Arterial Thrombosis During Pregnancymentioning

confidence: 93%

Section: Hereditary Thrombophilias and Venous Thrombosis During Pregnmentioning

confidence: 99%

Section: Venous Thromboembolism (Vte) In Pregnancymentioning

confidence: 99%

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Thrombophilia and pregnancy

Brenner¹

2005

Eur J Clin Investigation

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“…Se a suspeita clínica é alta, mas os testes não invasivos são negativos para TVP, a venografia limitada com proteção abdominal que resulta em exposição feral < 0,05 rads deve ser considerada 11 . Se o resultado do US é duvidoso (pequena área de não compressibilidade), a venografia ou a RNM devem ser solicitadas.…”

Section: Os Testes Diagnósticos Podem Ser Não Invasivos (Ultrassom [Uunclassified

15. Tromboembolismo venoso agudo

Gazzana¹,

Tedoldi²,

Barreto³

2009

Arq. Bras. Cardiol.

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“…Computed tomographic (CT) venography can be a useful adjunct in suspected iliac vein thrombosis in non-pregnant patients, but it carries much higher radiation exposure for the foetus than conventional venography and should therefore be avoided during pregnancy [72,73].…”

Section: Conventional and Ct Venographymentioning

confidence: 99%

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

Linnemann¹,

Scholz

Rott

et al. 2016

Vasa

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EpidemiologyVTE is a leading cause of maternal morbidity in the developed world and, in the case of PE, of mortality as well [1]. While the relative risk of VTE is greatly increased during pregnancy compared with that in non-pregnant women, the absolute risk remains low: estimates of the incidence of pregnancy-associated VTE have varied from 1:500 to 1:1500 pregnancies [2 -7]. The risk of VTE is approximately 5-fold greater in pregnant women than in non-pregnant women.Approximately 80 % of pregnancy-associated VTEs are isolated DVTs, and approximately 20 % are PEs or both DVTs and PEs [5]. Although a systematic review reported weighted event rates for DVT of 21.9 %, 33.7 % and 47.6 % for the fi rst, second and third trimesters, respectively [6], a recent study suggested that the risk might in fact increase exponentially over the duration of the pregnancy [7], with 12.4 % of VTEs diagnosed in the fi rst trimester, 15.3 % in the second trimester and 72.3 % in the third trimester. This detailed risk assessment for each gestational week demonstrated a 21-fold increased risk for the last two weeks before delivery [7]. Summary: Pregnancy and the postpartum period are associated with an increased risk of venous thromboembolism (VTE). Over the past decade, new diagnostic algorithms have been established, combining clinical probability, laboratory testing and imaging studies for the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the non-pregnant population. However, there is no such generally accepted algorithm for the diagnosis of pregnancy-associated VTE. Studies establishing clinical prediction rules have excluded pregnant women, and prediction scores currently in use have not been prospectively validated in pregnancy or during the postpartum period. D-dimers physiologically increase throughout pregnancy and peak at delivery, so a negative D-dimer test result, based on the reference values of non-pregnant subjects, becomes unlikely in the second and third trimesters. Imaging studies therefore play a major role in confi rming suspected DVT or PE in pregnant women. Major concerns have been raised against radiologic imaging because of foetal radiation exposure, and doubts about the diagnostic value of ultrasound techniques in attempting to exclude isolated iliac vein thrombosis grow stronger as pregnancy progresses. As members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH), we summarise evidence from the available literature and aim to establish a more uniform strategy for diagnosing pregnancy-associated VTE. Review Diagnosis of pregnancy-associated

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Risks to the Fetus of Radiologic Procedures Used in the Diagnosis of Maternal Venous Thromboembolic Disease

Cited by 189 publications

References 37 publications

Thrombophilia and pregnancy

Thrombophilia and pregnancy

15. Tromboembolismo venoso agudo

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

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