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Management of Venous Thromboembolism in Pregnancy

  • Pregnancy and Cardiovascular Disease (N Scott, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

This manuscript addresses the risks for venous thromboembolism (VTE) during pregnancy and the associated challenges of both diagnosis and treatment.

Recent findings

The obstacles to diagnosis given lack of specificity of typical biomarkers to predict VTE in pregnancy, as well as the unique fetal and bleeding risks introduced by managing massive pulmonary embolism (PE) with thrombolytics or thrombectomy are highlighted.

Summary

VTE during pregnancy and the postpartum window occurs at a 6–10-fold higher rate compared with age-matched peers and is a major cause of morbidity and mortality. Hypercoagulability persists for 6–8 weeks after delivery with the highest risk of PE being postpartum. The lack of randomized trials in pregnant women leads to variability in practice, which are largely based on expert consensus or extrapolation from non-pregnant cohorts. The standard treatment of VTE in pregnancy is anticoagulation with low molecular weight heparin (LMWH), which like unfractionated heparin does not cross the placenta and is not teratogenic. LMWH is preferred given the negligible risk for heparin-induced thrombocytopenia and osteoporosis, better bioavailability, and a predictive dose response. Depending on the severity of the VTE, additional treatments including thrombolysis, thrombectomy, inferior vena cava filter placement, or venous stenting may be used. Management requires balancing the competing bleeding and thrombotic risks during labor and delivery and factoring the impact of treatment on the fetus. A multidisciplinary team involving hematology, obstetrics, anesthesia, vascular medicine, and cardiology is critical for safe and timely management. The design and execution of prospective, randomized trials to specifically address optimal diagnosis and management are a top priority in obstetric hematology.

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Authors and Affiliations

  1. Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA

    Annemarie E. Fogerty MD

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  1. Annemarie E. Fogerty MD
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Correspondence to Annemarie E. Fogerty MD.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Pregnancy and Cardiovascular Disease

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Fogerty, A.E. Management of Venous Thromboembolism in Pregnancy. Curr Treat Options Cardio Med 20, 69 (2018). https://doi.org/10.1007/s11936-018-0658-3

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  • DOI: https://doi.org/10.1007/s11936-018-0658-3

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