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Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.

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Pregnancy and thrombotic risk.

Andra H James¹

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA. andra.james@duke.edu

Critical Care Medicine

|January 20, 2010

Summary

Pregnancy significantly elevates thrombosis risk due to hypercoagulability, a protective adaptation. Anticoagulation with heparins is recommended for high-risk pregnancies, potentially improving outcomes despite limited large-scale trial data.

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Area of Science:

Obstetrics and Gynecology
Hematology
Reproductive Medicine

Background:

Pregnancy naturally induces hypercoagulability, increasing thrombosis risk 3-4 fold.
This hypercoagulability, present from the first trimester, is an evolutionary adaptation to mitigate bleeding during childbirth and miscarriage.
Additional risk factors for thromboembolism in pregnancy include personal/family history of thrombosis, thrombophilia, and specific medical conditions or pregnancy complications.

Purpose of the Study:

To review the indications and management of anticoagulation in pregnancy.
To highlight the role of heparins as the preferred anticoagulation agents in pregnancy.
To discuss the evidence base and expert opinion guiding anticoagulation in pregnant women at risk.

Main Methods:

Review of existing literature, case series, and expert opinion on anticoagulation in pregnancy.
Analysis of risk factors contributing to thromboembolism during pregnancy and postpartum.
Evaluation of the safety and efficacy of heparin-based anticoagulation in this population.

Main Results:

Pregnancy-associated hypercoagulability is a significant risk factor for thrombosis.
Women with a history of thrombosis, thrombophilia, or poor pregnancy outcomes are candidates for anticoagulation.
Heparins are the preferred anticoagulants due to fetal safety considerations.

Conclusions:

Anticoagulation is indicated for specific high-risk pregnancies to prevent thromboembolic events.
While large trials are lacking, current evidence suggests anticoagulation improves pregnancy outcomes for at-risk women.
Expert consensus supports the use of heparins for anticoagulation during pregnancy.