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Review
. 2023 Jan 20;20(3):1949.
doi: 10.3390/ijerph20031949.

Thromboprophylaxis in Pregnant Women with COVID-19: An Unsolved Issue

Valentin Nicolae Varlas  1   2 , Roxana Georgiana Borș  1 , Mihaela Plotogea  2   3 , Madalina Iordache  4 , Claudia Mehedințu  1   2 , Monica Mihaela Cîrstoiu  2   5
Affiliations
Review

Thromboprophylaxis in Pregnant Women with COVID-19: An Unsolved Issue

Valentin Nicolae Varlas et al. Int J Environ Res Public Health. .

Abstract

SARS-CoV-2 infection in pregnant women is of growing interest due to controversy over the use of antiplatelet and/or anticoagulant drugs during pregnancy and postpartum. Pregnant women are susceptible to develop severe forms of viral infections due to pregnancy-related immune alterations, changes in lung functions, and hypercoagulability. The association of pregnancy with SARS-CoV-2 infection can cause an increased incidence of thrombotic complications, especially in the case of patients with some genetic variants that favor inflammation and thrombosis. Compared to the general population, pregnant women may be at increased risk of thrombotic complications related to COVID-19. The lack of extensive clinical trials on thromboprophylaxis and extrapolating data from non-pregnant patients lead to major discrepancies in treating pregnant women with COVID-19. Currently, a multidisciplinary team should determine the dose and duration of prophylactic anticoagulant therapy for these patients, depending on the disease severity, the course of pregnancy, and the estimated due date. This narrative review aims to evaluate the protective effect of thromboprophylaxis in pregnant women with COVID-19. It is unknown at this time whether antiplatelet or anticoagulant therapy initiated at the beginning of pregnancy for various diseases (preeclampsia, intrauterine growth restriction, thrombophilia) offers a degree of protection. The optimal scheme for thromboprophylaxis in pregnant women with COVID-19 must be carefully established through an individualized decision concerning gestational age and the severity of the infection.

Keywords: COVID-19; anticoagulant; antiplatelet; low-molecular-weight heparin; pregnancy; thromboprophylaxis; thrombosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The vicious circle of etiopathogenic factors in pregnant women with COVID-19.
Figure 2
Figure 2
Non-anticoagulant properties of LMWH.
Figure 3
Figure 3
Algorithm for thromboprophylaxis for pregnant women with COVID-19. (T1, T2, T3—first, second, and third trimester, VTE—venous thrombembolism, LMWH—low molecular weight heparin).
See this image and copyright information in PMC

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