Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period

Middleton, Philippa; Shepherd, Emily; Gomersall, Judith Streak

doi:10.1002/14651858.cd001689.pub4

Cited by 40 publications

(40 citation statements)

References 110 publications

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“…An updated Cochrane review on VTE prophylaxis during pregnancy and puerperium recently reported on the efficacy of antenatal ± postnatal heparin prophylaxis in 476 women from four clinical trials. 64 A wide indication for LMWH included primary prevention, prevention of pregnancy complications; thus, some women with thrombophilia, known family history of VTE, or caesarean section were at increased risk. In this meta-analysis, the use of LMWH versus no treatment or placebo was associated with a relative VTE risk (RR) of 0.39 (95% CI: 0.08–1.98).…”

Section: Risk Of Recurrent Vte Despite Thromboprophylaxismentioning

confidence: 99%

“…In this meta-analysis, the use of LMWH versus no treatment or placebo was associated with a relative VTE risk (RR) of 0.39 (95% CI: 0.08–1.98). 64 The review concluded that the evidence of heparin prophylaxis is still very uncertain regarding risk–benefit analysis. Trials with moderate to high bias were observed.…”

Section: Risk Of Recurrent Vte Despite Thromboprophylaxismentioning

confidence: 99%

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Thrombophilia, Thrombosis and Thromboprophylaxis in Pregnancy: For What and in Whom?

Naue

Köhler

2022

Hamostaseologie

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Compared with nonpregnant women, pregnancy carries a four- to fivefold higher risk of venous thromboembolism (VTE). Despite increasing use of heparin prophylaxis in identified high-risk patients, pulmonary embolism still is the leading cause of maternal mortality in the western world. However, evidence on optimal use of thromboprophylaxis is scarce. Thrombophilia, the hereditary or acquired tendency to develop VTE, is also thought to be associated with complications in pregnancy, such as recurrent miscarriage and preeclampsia. In this review, the current evidence on optimal thromboprophylaxis in pregnancy is discussed, focusing primarily on VTE prevention strategies but also discussing the potential to prevent recurrent pregnancy complications with heparin in pregnant women with thrombophilia.

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Section: Risk Of Recurrent Vte Despite Thromboprophylaxismentioning

confidence: 99%

Section: Risk Of Recurrent Vte Despite Thromboprophylaxismentioning

confidence: 99%

Thrombophilia, Thrombosis and Thromboprophylaxis in Pregnancy: For What and in Whom?

Naue

Köhler

2022

Hamostaseologie

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“…21 In my practice, I would offer prophylactic dose LMWH with natural conception or at the start of ART, not only for the prevention of RPL but also for the protection of the patient from thromboembolic complications, such as pulmonary embolism, based on the recommendations from the ACCP and ESHRE guidelines and data from systematic review. 28 Case Vignette 3 A 31-year-old woman presented with history of ART complicated by repeated implantation failure, two chemical pregnancies, and a 9-week pregnancy loss after IVF with preimplantation genetic screening. Hysterosalpingogram was unremarkable.…”

Section: Piazza's Perspectivementioning

confidence: 99%

Thrombophilia, Inflammation, and Recurrent Pregnancy Loss: A Case-Based Review

Piazza

2021

Semin Reprod Med

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Recurrent pregnancy loss (RPL) is defined as the loss of two or more pregnancies and is often multifactorial with the majority of miscarriages being due to aneuploidy and anatomic or physiological abnormalities. However, inherited or acquired thrombophilias have also been associated with RPL, albeit inconsistently. While inherited thrombophilias, such as factor V Leiden and prothrombin gene mutation, are relatively prevalent in women with RPL compared with the general population, a causal link has yet to be definitively established. Recently, systemic inflammation, as measured by high-sensitivity C-reactive protein, has also been hypothesized to play a role in infertility. Based on limited prospective trial data, antithrombotic therapy and antiplatelet agents have been proposed as possible tools for the prevention of RPL. Because of the multifactorial nature of RPL and infertility, various clinicians, as obstetricians and gynecologists, endocrinologists, hematologists, or vascular medicine specialists, may be requested to counsel these women. This, together with evidence gaps, frequently leads to distinctly different diagnostic and therapeutic recommendations, especially regarding thrombophilia testing and treatment. Using four case vignettes in this review, we critically appraise the literature and highlight how two clinicians from different subspecialties approach the relationship between RPL, inflammation, and thrombophilia.

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“…In an updated Cochrane sys tem atic review of avail able ran dom ized trials, the lim ited evi dence remains "very uncer tain about the ben efits and harms of VTE thromboprophylaxis" dur ing preg nancy and the post par tum period. 24 More spe cifi cally, there are dif fer ences in how the lim ited data are interpreted, which can lead to dif ferent guide line rec om men da tions. This includes issues of pub li cation date, what sta tis ti cal strat e gies are used to com bine mul ti ple VTE RFs together, what VTE risk thresh old is set to rec om mend LMWH, if a VTE scor ing sys tem is used, and the role of expert and patient opin ion.…”

Section: Clinical Casementioning

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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Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period

Cited by 40 publications

References 110 publications

Thrombophilia, Thrombosis and Thromboprophylaxis in Pregnancy: For What and in Whom?

Thrombophilia, Thrombosis and Thromboprophylaxis in Pregnancy: For What and in Whom?

Thrombophilia, Inflammation, and Recurrent Pregnancy Loss: A Case-Based Review

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

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