Risk factors, diagnosis and management of venous thromboembolic disease in pregnancy

Abstract

Venous thromboembolism (VTE) in pregnancy is a leading cause of maternal morbidity and mortality. However, despite the significant associated clinical burden and potentially devastating societal impact, there is still a paucity of data surrounding its prevention and management. Consequently, international guideline recommendations vary widely. Exclusion of pregnant women from clinical trials in the past has contributed to knowledge gaps. However, recently published and ongoing studies demonstrate that excellent clinical trials in pregnancy are achievable. This review will discuss prevention, diagnosis and treatment of VTE in pregnancy, and will also explore priorities for future research.

Educational aims: To gain an understanding of current knowledge on risk factors for pregnancy-associated venous thromboembolism (PA-VTE).To gain an understanding of the diagnosis of PA-VTE.To review up-to-date approaches to preventing and treating PA-VTE.To discuss possible limitations in current research and areas which require improvement.

FIGURE 1

Venous thromboembolism (VTE) duration of anticoagulation based on risk. For pregnant women with prior VTE (especially those with an unprovoked or a hormone-provoked VTE), predicted recurrence risk during pregnancy is high enough to warrant both antenatal and postnatal thromboprophylaxis, whereas only postpartum thromboprophylaxis is recommended for women with lower predicted recurrence risks. The optimal low molecular weight heparin (LMWH) dose for women with prior VTE is currently being investigated in the ongoing Highlow study. Reproduced and modified from [14] with permission.