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How Do We Treat Pregnancy-Related Venous Thromboembolism?

Abstract

Venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality during pregnancy and the postpartum period. Due to a lack of adequate study data, therapeutic strategies for pregnancy-related VTE are deduced from observational studies and extrapolated from recommendations for nonpregnant patients. Because heparins do not cross the placenta, weight-adjusted therapeutic-dose low-molecular-weight heparins (LMWHs) are the anticoagulant treatment of choice in cases of VTE during pregnancy. Once- and twice-daily dosing regimens are suitable. There is no evidence that measurement of factor Xa activities and consecutive LMWH dose adjustments improve clinical outcomes. There is no support for the routine use of vitamin K antagonists, direct oral thrombin or factor Xa inhibitors, fondaparinux, or danaparoid in uncomplicated pregnancy-related VTE. Management of delivery deserves special attention, and treatment strategies depend on the time interval between the diagnosis of acute VTE and the expected delivery date. In lactating women, an overlapping switch from LMWH to warfarin is possible. Anticoagulation should be continued for at least 6 weeks postpartum or for a minimum period of 3 months.

Authors+Show Affiliations

Division of Angiology, University Center of Vascular Medicine, University Hospital Regensburg, Regensburg, Germany.Department of Obstetrics and Gynaecology of the University Hospital Regensburg, St. Hedwig Clinic, Regensburg, Germany.Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Germany.Department of Haematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31683346

Citation

Linnemann, Birgit, et al. "How Do We Treat Pregnancy-Related Venous Thromboembolism?" Hamostaseologie, 2019.
Linnemann B, Seelbach-Goebel B, Heimerl S, et al. How Do We Treat Pregnancy-Related Venous Thromboembolism? Hamostaseologie. 2019.
Linnemann, B., Seelbach-Goebel, B., Heimerl, S., & Hart, C. (2019). How Do We Treat Pregnancy-Related Venous Thromboembolism? Hamostaseologie, doi:10.1055/s-0039-1700501.
Linnemann B, et al. How Do We Treat Pregnancy-Related Venous Thromboembolism. Hamostaseologie. 2019 Nov 4; PubMed PMID: 31683346.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - How Do We Treat Pregnancy-Related Venous Thromboembolism? AU - Linnemann,Birgit, AU - Seelbach-Goebel,Birgit, AU - Heimerl,Susanne, AU - Hart,Christina, Y1 - 2019/11/04/ PY - 2019/11/5/entrez PY - 2019/11/5/pubmed PY - 2019/11/5/medline JF - Hamostaseologie JO - Hamostaseologie N2 - Venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality during pregnancy and the postpartum period. Due to a lack of adequate study data, therapeutic strategies for pregnancy-related VTE are deduced from observational studies and extrapolated from recommendations for nonpregnant patients. Because heparins do not cross the placenta, weight-adjusted therapeutic-dose low-molecular-weight heparins (LMWHs) are the anticoagulant treatment of choice in cases of VTE during pregnancy. Once- and twice-daily dosing regimens are suitable. There is no evidence that measurement of factor Xa activities and consecutive LMWH dose adjustments improve clinical outcomes. There is no support for the routine use of vitamin K antagonists, direct oral thrombin or factor Xa inhibitors, fondaparinux, or danaparoid in uncomplicated pregnancy-related VTE. Management of delivery deserves special attention, and treatment strategies depend on the time interval between the diagnosis of acute VTE and the expected delivery date. In lactating women, an overlapping switch from LMWH to warfarin is possible. Anticoagulation should be continued for at least 6 weeks postpartum or for a minimum period of 3 months. SN - 2567-5761 UR - https://www.unboundmedicine.com/medline/citation/31683346/How_Do_We_Treat_Pregnancy-Related_Venous_Thromboembolism L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0039-1700501 DB - PRIME DP - Unbound Medicine ER -