Pregnancy-Related Venous Thromboembolism

• Published in: Journal of pharmacy practice Vol. 27; no. 3; p. 243
• Main Authors: Armstrong, Emily M, Bellone, Jessica M, Hornsby, Lori B, Treadway, Sarah, Phillippe, Haley M
• Format: Journal Article
• Language: English
• Published: United States 01.06.2014
• Subjects: Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Cesarean Section - adverse effects; Female; Heparin - adverse effects; Heparin - therapeutic use; Heparin, Low-Molecular-Weight - adverse effects; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Maternal Age; Obesity - complications; Pregnancy; Pregnancy Complications, Hematologic - drug therapy; Pregnancy Complications, Hematologic - prevention & control; Risk Factors; Smoking - adverse effects; Venous Thromboembolism - drug therapy; Venous Thromboembolism - etiology; Venous Thromboembolism - prevention & control; thrombophilia; inherited thrombophilia; prophylaxis; acquired thrombophilia; pregnancy
• ISSN: 0897-1900; 1531-1937
• DOI: 10.1177/0897190014530425

Pregnancy is associated with an increased risk of venous thromboembolism (VTE), with a reported incidence ranging from 0.49 to 2 events per 1000 deliveries. Risk factors include advanced maternal age, obesity, smoking, and cesarian section. Women with a history of previous VTE are at a 4-fold higher risk of recurrent thromboembolic events during subsequent pregnancies. Additionally, the presence of concomitant thrombophilia, particularly factor V Leiden (homozygosity), prothrombin gene mutation (homozygosity), or antiphospholipid syndrome (APS), increases the risk of pregnancy-related VTE. Low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) are the drugs of choice for anticoagulation during pregnancy. LMWH is preferred due to ease of use and lower rates of adverse events. Women with high thromboembolic risk particularly those with a family history of VTE should receive antepartum thromboprophylaxis. Women with low thromboembolic risk or previous VTE caused by a transient risk factor (ie, provoked), who have no family history of VTE, may undergo antepartum surveillance. Postpartum anticoagulation can be considered in women with both high and low thromboembolic risk.