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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Venous thromboembolism in pregnancy
1Section of Vascular Medicine, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-5, Cleveland, OH 44195, USA. gomesm3@ccf.org
Current Treatment Options in Cardiovascular Medicine
|March 18, 2009
Summary
Low molecular weight heparins (LMWHs) are safe for treating pregnancy-related venous thromboembolic disease (VTED). However, optimal dosing, monitoring, and management near delivery require further study.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Pharmacology
Background:
- Low molecular weight heparins (LMWHs) and unfractionated heparin (UFH) are mainstays for venous thromboembolic disease (VTED) management during pregnancy.
- Limited data exist for other parenteral anticoagulants, and no oral alternatives are approved.
Purpose of the Study:
- To review the current evidence and challenges of using LMWH for VTED treatment and prophylaxis in pregnant individuals.
- To discuss optimal dosing, monitoring, and management strategies as pregnancy progresses and delivery approaches.
Main Methods:
- Review of existing literature on LMWH and UFH use in pregnancy for VTED.
- Discussion of clinical considerations for anticoagulation management in high-risk pregnancies.
Main Results:
- LMWH demonstrates comparable safety and efficacy to UFH for VTED during pregnancy.
- Unanswered questions remain regarding ideal dosing, anti-Xa monitoring, and peripartum management.
- Current evidence suggests most thrombophilias or situational VTED do not necessitate antepartum prophylaxis, but postpartum prophylaxis is often recommended.
Conclusions:
- While LMWH is a viable option, further prospective trials are needed to address dosing, monitoring, and management challenges.
- Anticoagulation strategies should be individualized, particularly for high-risk patients, with a focus on postpartum prophylaxis where indicated.
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