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Published on: February 10, 2023
Venous thromboembolism in pregnancy
1Division of Maternal-Fetal Medicine Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA. andra.james@duke.edu
Arteriosclerosis, Thrombosis, and Vascular Biology
|February 21, 2009
Summary
Pregnancy increases the risk of venous thromboembolism (VTE) due to hypercoagulability. Heparins are the preferred anticoagulants for pregnant women with VTE, improving pregnancy outcomes.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Public Health
Background:
- Pregnancy is associated with a hypercoagulable state, increasing the risk of venous thromboembolism (VTE).
- This hypercoagulability, likely an evolutionary adaptation to mitigate bleeding during childbirth, begins in the first trimester.
- Additional risk factors for VTE in pregnancy include personal or family history of thrombosis, thrombophilia, and specific medical conditions or pregnancy complications.
Purpose of the Study:
- To review the epidemiology of venous thromboembolism (VTE) during pregnancy.
- To outline current strategies for the prevention and treatment of VTE in pregnant individuals.
Main Methods:
- This is a review article, synthesizing existing literature and expert opinion.
- Key risk factors and epidemiological data on VTE in pregnancy were identified and summarized.
- Treatment and prevention strategies, including the role of anticoagulation, were examined.
Main Results:
- Hypercoagulability is the primary driver of increased VTE risk in pregnancy, starting from the first trimester.
- Women with a history of thrombosis, thrombophilia, or specific pregnancy-related risk factors are candidates for anticoagulation.
- Heparins are the recommended anticoagulants during pregnancy due to fetal safety considerations.
Conclusions:
- Anticoagulant therapy, particularly with heparins, is recommended for pregnant women with VTE or at high risk.
- While large-scale trials are lacking, evidence suggests anticoagulants improve pregnancy outcomes in affected women.
- Management strategies are based on case series and expert consensus, emphasizing individualized risk assessment.
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