Thromboembolism in pregnancy

Current Opinion in Obstetrics and Gynecology

Volumn 17, Issue 2, 2005, Pages 113-116

  Robertson, Lindsay ^a   Greer, Ian ^a  

^a UNIVERSITY OF GLASGOW   (United Kingdom)

Author keywords

Adverse pregnancy complications; Thrombophilia

Indexed keywords

ANTICOAGULANT AGENT; BLOOD CLOTTING FACTOR 5 LEIDEN;

ANTICOAGULANT THERAPY; CAUSE OF DEATH; CESAREAN SECTION; CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; DRUG EFFICACY; ECONOMIC EVALUATION; GENETIC POLYMORPHISM; HIGH RISK PATIENT; HUMAN; INCIDENCE; LUNG EMBOLISM; MATERNAL MORTALITY; PRACTICE GUIDELINE; PREGNANCY COMPLICATION; PREVALENCE; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL; REVIEW; RISK ASSESSMENT; RISK FACTOR; SCREENING; THROMBOPHILIA; THROMBOSIS PREVENTION; VENOUS THROMBOEMBOLISM;

EID: 15944388260     PISSN: 1040872X     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.gco.0000162177.30607.59     Document Type: Review

References (27)

1. Greer IA. Thrombosis in pregnancy: Maternal and fetal issues. Lancet 1999; 353:4-10.
2. Toglia MR, Weg JG. Venous thromboembolism during pregnancy. N Engl J Med 1996; 335:108-114.
3. Seligsohn U, Zivelin A. Thrombophilia as a multigenic disorder. Thromb Haemost 1997; 78:297-301.
4. Gerhardt A, Scharf RE, Beckmann MW, et al. Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and the puerperium. N Engl J Med 2000; 342:374-380.
5. Greer IA. The challenge of thrombophilia in maternal-fetal medicine. N Engl J Med 2000; 342:424-425.
6. Tumball A, Tindall VR, Beard RW. Report on confidential enquiries into maternal death in England and Wales 1982-1984. Report no. 28. London: HMSO; 1989.
7. Greer IA. Epidemiology, risk factors and prophylaxis of venous thromboembolism in obstetrics and gynaecology. Baillieres Clin Obstet Gynaecol 1997; 11:403-430.
8. Macklon NS, Greer IA. Venous thromboembolic disease in obstetrics and gynaecology: the Scottish experience. Scot Med J 1996; 41:83-86.
9. Badracco MA, Vessey M. Recurrence of venous thromboembolism and the use of oral contraceptives. BMJ 1974; 2:215-217.
10. Lockwood CJ. Inherited thrombophilias in pregnant patients: Detection and treatment paradigm. Obstet Gynecol 2002; 99:333-341.
11. Kupferminc MJ. Thrombophilia and pregnancy. Reprod Biol Endocrinol 2003; 1:111. A global review outlining all aspects of thrombophilia in pregnancy. Venous thromboembolism in pregnancy is discussed in detail, with results of studies presented to support the risk and recommendations for management. Authors also provide extensive information on the risk of other adverse obstetric complications associated with thrombophilia, again using evidence from the literature.
12. Walker ID, Greaves M, Preston FE, on behalf of the Haemostasis and Thrombosis Task Force British Committee for Standards in Haematology. Investigation and management of heritable thrombophilia. Br J Haematol 2001; 114:512-528.
13. Greer IA. Inherited thrombophilia and venous thromboembolism. Best Pract Res Clin Obstet Gynaecol 2003; 17:413-425.
14. Rosendaal FR. Venous thrombosis: a multicausal disease. Lancet 1999; 353:1167-1173.
15. Hague WM, Dekker GA. Risk factors for thrombosis in pregnancy. Best Pract Res Clin Haematol 2003; 16:197-210. Comprehensive article that reviews genetic, acquired and environmental factors and their interaction in the promotion of thrombosis during pregnancy.
16. Gerhardt A, Scharf R, Zotz R. Effect of hemostatic risk factors on the individual probability of thrombosis during pregnancy and the puerperium. Thromb Haemost 2003; 90:77-85. This retrospective case-control study (n = 380) examined individual risk of venous thromboembolism in pregnant women. Odds ratios and individual probability of venous thromboembolism for different degrees of deficiencies in women with venous thromboembolism in pregnancy are presented. However, complete data were not available for all women with a history of venous thromboembolism. Authors give possible explanations as to why their results differ from those of other studies and hypothesize that single risk factors for thrombosis in pregnancy tend to be overestimated.
17. Meglic L, Stegnar M, Milanez T, et al. Factor V Leiden, prothrombin 20210G>A, methylenetetrahydrofolate reductase 677C>T and plasminogen activator inhibitor 4G/5G polymorphism in women with pregnancy-related venous thromboembolism. Eur J Obstet Gynecol Reprod Biol 2003; 111:157-163. A small, retrospective case-control study reporting an association between inherited thrombophilia and pregnancy-related venous thromboembolism.
18. Samama MM, Rached Ra. Horellou M, et al. Pregnancy-associated venous thromboembolism (VTE) in combined heterozygous factor V Leiden (FVL) and prothrombin (FII) 20210 A mutation and in heterozygous FII single gene mutation alone. Br J Haematol 2003; 123:327-334. A retrospective cohort study of women with double and single thrombophilic mutations which found that women with combined mutations are almost three times more likely to suffer a venous thromboembolism in pregnancy. Even women with no history of venous thromboembolism before pregnancy had an increased risk.
19. Khare M, Nelson-Piercy C. Acquired thrombophilias and pregnancy. Best Pract Res Clin Obstet Gynaecol 2003; 17:491-507. A detailed article that covers the pathogenesis of the antiphospholipid syndrome and its manifestations in pregnancy.
20. Brenner B. Antithrombotic prophylaxis for women with thrombophilia and pregnancy complications - yes. J Thromb Haemost 2003; 1:2070-2072. A letter supporting the use of antithrombotic agents as prophylaxis for preventing venous thromboembolism in pregnancy.
21. Rosene-Montella K. Pregnancy-related thrombosis and thrombophilia update: a case for prevention. J Obstet Gynaecol 2003; 23:550-554. Comprehensive review examining risk factors that contribute to the incidence of venous thromboembolism in pregnancy. Authors present evidence from individual studies and give short interpretations of these results. A short section of the paper is devoted to thrombophilias and the effect on the risk of venous thromboembolism and other obstetric complications. Strategies for diagnosis, treatment and prevention of venous thromboembolism in pregnancy are also summarized.
22. Bowles L, Cohen H. Inherited thrombophilia and anticoagulation in pregnancy. Best Pract Res Clin Obstet Gynaecol 2003; 17:471-489. Authors discuss anticoagulation for women with inherited thrombophilic disorders, define criteria for thromboprophylaxis and explore other therapeutic options for the management of thrombophilia in pregnancy.
23. Conard J. Antithrombotic prophylaxis in women with thrombophilia and pregnancy complications. J Thromb Haemost 2004; 2:1190-1192. Short review that discusses prophylaxis in women with thrombophilia in pregnancy and presents results from the literature.
24. Gates S, Brocklehurst P, Davis LJ. Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period [Cochrane review]. In: The Cochrane Library, issue 3, Oxford: Update Software; 2003. A good meta-analysis of eight small trials. There is still insufficient evidence available on which to base any recommendations and more studies are necessary.
25. Royal College of Obstetricians and Gynaecologists. Thromboprophylaxis during pregnancy, labour and after vaginal delivery. Guideline no. 37. London: RCOG Press; 2004. A guideline that comprehensively summarizes the evidence on the prevention of venous thromboembolism during pregnancy and proposes key recommendations for clinicians to follow.
26. Gerhardt A, Scharf RE, Beckmann MW, et al. Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and the puerperium. N Engl J Med 2000; 342:374-380.
27. Clark P, Twaddle S, Walker ID, et al. Cost-effectiveness of screening for the factor V Leiden mutation in pregnant women. Lancet 2002; 359:1919-1920.