Thromboprophylaxis during the Pregnancy-Puerperal Cycle - Literature Review

Abstract

Objective To identify current strategies and recommendations for venous thromboembolism prophylaxis associated with the pregnancy-puerperal cycle, a condition of high morbidity and mortality among women. Methods The literature search was performed between May and October 2019, using the PubMed database, including papers published in Portuguese, English and Spanish. The terms thromboembolism (Mesh) AND pregnancy (Mesh) OR postpartum (Mesh) were used as descriptors, including randomized controlled trials, meta-analyses, systematic reviews and guidelines published from 2009 to 2019, presenting strategies for prevention of thromboembolism during pregnancy and the postpartum. Results Eight articles met the inclusion criteria. Many studies evaluated were excluded because they did not address prevention strategies. We compiled the recommendations from the American Society of Hematologists, the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynaecologists of Canada, the American College of Chest Physicians and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Conclusion: There are some gaps in the research, and clinical studies with appropriate methodology are needed to support decisions made regarding the risk of thromboembolism in the perigestational period. Thus, the attention of the professionals involved in the care of pregnant and postpartum women is crucial, as it is a condition associated with high morbidity and mortality.

Evaluating Thromboprophylaxis Strategies for High-Risk Pregnancy: A Current Perspective

“…Thus, there is a difference in the situation when the patient has a history of unprovoked VTE or an episode of VTE associated with transient risk factors ( Table 2 ) [ 70 ].…”

Isolation and freezing of human peripheral blood mononuclear cells from pregnant patients

“…The protocol below describes the specific steps for isolating and freezing PBMCs from pregnant patients. The challenge of the procoagulant state of pregnancy ( Sanches et al., 2020 ) (including an increase in clotting factors, reduced anticoagulant and fibrinolytic activity) made density centrifugation difficult, as the plasma layer was stained with blood. We found that use of EDTA in PBS to the blood before centrifugation improved separation and yield.…”

“…This can be seen in Figure 1 , which demonstrates a comparison of diluted blood samples with PBS without EDTA ( Figure 1 A) and the addition of 1 mM of EDTA ( Figure 1 B). We considered the differences in haemostatic profile in pregnant women vs healthy controls – during pregnancy, the significant increase in clotting factors, reduced quantity of anticoagulants and reduced fibrinolytic activity creates a state of hypercoagulability ( Sanches et al., 2020 ). This likely makes density centrifugation more complicated, and why the anticoagulant EDTA helped reduce blood contamination.…”

Estratégia nutricional para o emagrecimento pós-parto

“…É importante que as mulheres adotem um padrão alimentar, no período de amamentação, pois uma dieta mista, podem desacelerar o processo de perda de peso (Gomes et al, 2021;Souza, 2015;Sanches et al, 2020).…”