Venous thromboembolism during pregnancy or postpartum: Findings from the RIETE Registry

Blanco-Molina, Ángeles; Trujillo‐Santos, Javier; Criado, Juan Carlos Hernández; López, Luciano Espino; Lecumberri, Ramón; Gutiérrez, Reyes; Monréal, Manuel

doi:10.1160/th06-11-0650

Cited by 115 publications

(107 citation statements)

References 20 publications

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“…T wave inversion (21 % of cases), S1Q3 pattern (15 % of cases) and right bundle branch block (18 % of cases during pregnancy) have been described as the most common fi ndings. In the same cohort, arterial blood gas analysis revealed hypoxaemia or decreased oxygen saturation in only a minority of patients (prevalence in confi rmed PE of 18 % and 3 %, respectively) [48].…”

Section: Diagnostic Workup -General Considerationsmentioning

confidence: 84%

“…Isolated iliac vein thrombosis can be accompanied by pain in the buttocks, groin, fl ank, or abdomen [19,47]. PE should be considered, particularly if the woman presents with dyspnoea (87 % of cases) and pleuritic chest pain (61 % of cases) [48]. Tachycardia, tachypnoea, hypoxaemia, haemoptysis, syncope, coughing, and unexplained hypotension may also be present.…”

Section: Clinical Presentationmentioning

confidence: 99%

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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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Section: Diagnostic Workup -General Considerationsmentioning

confidence: 84%

Section: Clinical Presentationmentioning

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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show abstract

“…This corresponds to the maternal pregnancy-related physiologic alterations of hemostatic parameters, with the peak of the pro-coagulant state in the third trimester and early postpartum period, potentiated by the inherent vascular damage sustained at time of delivery. Yet, while the VTE risk predominates during these time periods, the magnitude of risk in the first and second trimesters should not be underestimated [9], and may be heightened by the pro-coagulant states associated with early stages of pregnancy, such as hyperemesis gravidarum or ovarian hyperstimulation syndrome [10].…”

Section: Epidemiologymentioning

confidence: 99%

“…Twice-daily dosing for maintenance of therapeutic levels has been proposed by some [16,31], while once-daily dosing is supported by others [55]. Similarly, the need for anti-FXa monitoring remains unclear [9,16,31].…”

Section: Anticoagulation Dosage Duration and Peripartum Managementmentioning

confidence: 99%

Venous thromboembolism in obese pregnant women: approach to diagnosis and management

et al. 2017

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Venous thromboembolism (VTE) remains among the leading causes of maternal mortality in the developed world, presenting variably as deep vein thrombosis (DVT), pulmonary embolism (PE) or cerebral vein thrombosis (CVT), among others. Obesity in particular has been recognized as the principal contributing factor to the risk of VTE in pregnancy and with the global increase in the rates of obesity affecting reproductive age women, heightened awareness of the risk and consequences of VTE in this population are vital. Thus, prophylaxis, diagnosis and treatment of VTE in the obese gravida are discussed.

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“…13,21,24,41,42 Other risk factors for VTE and their respective relative risks are listed in Table 1.…”

Section: Other Risk Factorsmentioning

confidence: 99%

Profilaxia de tromboembolismo venoso na gestação

Oliveira¹,

Marques

2016

J. vasc. bras.

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Venous thromboembolism is a major cause of obstetric morbidity and mortality. During pregnancy, the risk of occurrence increases between five and ten times when compared to women of the same age who are not pregnant. Compounding this is the fact that pregnant women present certain characteristics that make diagnosis more difficult using clinical signs (high frequency of pain and swelling in the lower limbs), echographic examination (lower sensitivity and specificity for diagnosis of iliac vein thrombosis as pregnancy progresses), and laboratory findings (D-dimer levels progressively increase throughout pregnancy). Conducting careful stratification of women' s venous thromboembolism risk before pregnancy could reduce the incidence of this disease, which is frequent and difficult to diagnose during pregnancy, and of its complications.Keywords: venous thrombosis; prophylaxis; pregnancy. ResumoO tromboembolismo venoso é importante causa de morbidade e mortalidade obstétrica. Durante a gestação, o risco de sua ocorrência aumenta entre cinco e dez vezes quando comparado ao de mulheres não gestantes de mesma idade. Associado a esse fato, a gestante apresenta algumas limitações para o diagnóstico clínico (alta frequência de dor e edema nos membros inferiores), ecográfico (menor sensibilidade e especificidade no diagnóstico de trombose venosa de ilíaca com a evolução da gestação) e laboratorial (o D-dímero apresenta aumento progressivo no decorrer da gravidez). Uma estratificação criteriosa de risco de tromboembolismo venoso de cada mulher antes da gestação pode diminuir a incidência dessa doença, frequente e de difícil diagnóstico na gravidez, e suas complicações.

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Venous thromboembolism during pregnancy or postpartum: Findings from the RIETE Registry

Cited by 115 publications

References 20 publications

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

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

Venous thromboembolism in obese pregnant women: approach to diagnosis and management

Profilaxia de tromboembolismo venoso na gestação

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