Thromboembolic Disease in Pregnancy

de Swiet's Medical Disorders in Obstetric Practice: Fifth Edition

Volumn , Issue , 2010, Pages 82-100

  Nelson Piercy, Catherine ^a   Greer, Ian ^b  

^a QUEEN CHARLOTTE S AND CHELSEA HOSPITAL   (United Kingdom)

^b UNIVERSITY OF LIVERPOOL   (United Kingdom)

Author keywords

D dimer testing in nonpregnant patients; Inherited and acquired tendencies to thrombosis and testing for them in pregnancy; LMWH doses for thromboprophylaxis in pregnancy and puerperium; Maintenance treatment of venous thromboembolism; Pulmonary thromboembolism (PTE) major cause of direct maternal mortality; Risk factors for VTE associated with pregnancy; Thromboembolic disease in pregnancy; Venous thromboembolism (VTE) 10 times more common in pregnant women; Venous thromboembolism acute treatment; Venous thromboembolism prevention in pregnancy

Indexed keywords

EID: 84885715520     PISSN: None     EISSN: None     Source Type: Book    
DOI: 10.1002/9781444323016.ch3     Document Type: Chapter

References (99)

1. Lewis G (ed). The confidential enquiry into maternal and child health (CEMACH). Saving mothers" lives: reviewing maternal deaths to make motherhood safer 2003-2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the UK. Department of Health, London, 2007.
2. Macklon NS, Greer IA. Venous thromboembolic disease in obstetrics and gynaecology: the Scottish experience. Scott Med J 1996;41:83-86.
3. Lindqvist P, Dahlback B, Marsal K. Thrombotic risk during pregnancy: a population study. Obstet Gynecol 1999;94: 595-9.
4. Andersen BS, Steffensen FH, Sorensen HT, Nielsen GL, Olsen J. The cumulative incidence of venous thromboembolism during pregnancy and puerperium - an 11 year Danish populationbased study of 63,300 pregnancies. Acta Obstet Gynecol Scand 1998;77:170-3.
5. Gherman RB, Goodwin TM, Leung T, et al. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol 1999;94:730-4.
6. McColl MD, Ramsay JE, Tait RC, et al. Risk factors for pregnancy associated venous thromboembolism. Thromb Haemost 1997;78:1183-8.
7. White RH. The epidemiology of venous thromboembolism. Circulation 2003;107:14-18.
8. Ray JG, Chan WS. Deep vein thrombosis during pregnancy and the puerperium: a meta-analysis of the period of risk and the leg of presentation. Obstet Gynecol Surv 1999;54:265-71.
9. Blanco-Molina A, Trujillo-Santos J, Criado J, et al. Venous thromboembolism during pregnancy or postpartum: findings from the RIETE Registry. Thromb Haemost 2007;97:186-90.
10. Greer IA, Thomson AJ. Management of venous thromboembolism in pregnancy. Best Pract Res Clin Obstet Gynaecol 2001;15:583-603.
11. Berg CJ, Atrash HK, Koonin LM, Tucker M. Pregnancy-related mortality in the United States, 1987-1990. Obstet Gynecol 1996;88:161-7.
12. Chang J, Elam-Evans LD, Berg CJ, et al. Pregnancy-related mortality surveillance - United States, 1991-1999. MMWR Surveill Summ 2003;52:1-8.
13. Bounameaux H, Perrier A. Duration of anticoagulation therapy for venous thromboembolism. Hematol Am Soc Hematol Educ Program 2008;2008:252-8.
14. McColl M, Ellison J, Greer IA, et al. Prevalence of the postthrombotic syndrome in young women with previous venous thromboembolism. Br J Haematol 2000;108:272-4.
15. Bergqvist D, Bergqvist A, Lindhagen A, et al. Long-term outcome of patients with venous thromboembolism during pregnancy. In: Greer IA, Turpie AGG, Forbes CD (eds) Haemostasis and thrombosis in obstetrics and gynaecology. Chapman and Hall, London, 1992: 349-59.
16. Scarsbrook AF, Evans AL, Owen AR, Gleeson FV. Diagnosis of suspected venous thromboembolic disease in pregnancy. Clin Radiol 2006;61:1-12.
17. Thomson AJ, Greer IA. Acute management of venous thromboembolism in pregnancy. Royal College of Obstetricians and Gynaecologists, London, 2007.
18. Ferrari E, Baudout M, Cerboni P, et al. Clinical epidemiology of venous thromboembolic disease: results of a French multicentre registry. Eur Heart J 1997;18:685-91.
19. Fidler JL, Patz Jr EF, Ravin CE. Cardiopulmonary complications of pregnancy: radiographic findings. Am J Roentgenol 1993:161:937-42.
20. Damilakis J, Perisinakis K, Prassopoulos P, Dimovasili E, Varveris H, Gourtsoyiannis N. Conceptus radiation dose and risk from chest screen-film radiography. Eur Radiol 2003;13(2):406-12.
21. Wells PS, Ginsberg JS, Anderson DR, et al. Utility of ultrasound imaging of the lower extremities in the diagnostic approach in patients with suspected pulmonary embolism. J Intern Med 2001;250:262-4.
22. MacGillavry MR, Sanson BJ, Buller HR, et al. Compression ultrasonography of the leg veins in patients with clinically suspected pulmonary embolism: is a more extensive assessment of compressibility useful? Thromb Haemostas 2000;84:973-6.
23. Turkstra F, Kuijer PM, van Beek EJ, et al. Diagnostic utility of ultrasonography of leg veins in patients suspected of having pulmonary embolism. Ann Intern Med 1997;126:775-81.
24. Cook JV, Kyrion J. Radiation from CT and perfusion scanning in pregnancy. BMJ 2005;331:350.
25. Nijkeuter M, Geleijns J, de Roos A, Meinders AE, Huisman MV. Diagnosing pulmonary embolism in pregnancy: rationalizing fetal radiation exposure in radiological procedures. J Thromb Haemost 2004;2(10):1857.
26. Winer-Muram HT, Boone JM, Brown HL, Jennings SG, Mabie WC, Lombardo GT. Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. Radiology 2002;224(2):487-9.
27. Remy-Jardin M, Remy J. Spiral CT angiography of the pulmonary circulation. Radiology 1999;212(3):615-36.
28. Allen C, Demetriades T. Radiation risk overestimated. Radiology 2006;240(2):613-14.
29. Francalanci I, Comeglio P, Alessandrello Liotta A, et al. D-dimer plasma levels during normal pregnancy measured by specific ELISA. Int J Clin Lab Res 1997;27(1):65-7.
30. Kline JA, Williams GW, Hernandez-Nino J. D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem 2005;51(5):825-9.
31. Chan WS, Chunilal S, Lee A, Crowther M, Rodger M, Ginsberg JS. A red blood cell agglutination D-dimer test to exclude deep venous thrombosis in pregnancy. Ann Intern Med 2007;147(3):165-70.
32. Damodaram M, Kaladindi M, Luckit J, Yoong W. D-dimers as a screening test for venous thromboembolism in pregnancy: is it of any use? J Obstet Gynaecol 2009;29(2):101-3.
33. Gould MK, Dembitzer AD, Doyle RL, et al. Low molecular weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A meta-analysis of randomized, controlled trials. Ann Intern Med 1999;130: 800-9.
34. Quinlan DJ, McQuillan A, Eikelboom JW. Low-molecular-weight heparin compared with intravenous unfractionated heparin for treatment of pulmonary embolism: a meta-analysis of randomized, controlled trials. Ann Intern Med 2004;140:175-83.
35. Greer IA, Nelson-Piercy C. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 2005;106:401-7.
36. Yusen RD, Gage BF. Outpatient treatment of acute thromboembolic disease. Clin Chest Med 2003;24:46-61.
37. Hirsh, J. Warkentin TE, Shaughnessy SG, et al. Heparin and low-molecular weight heparin: mechanism of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest. 2001;119(suppl 1):64S-94S.
38. Bates SM, Greer IA, Hirsh J, Ginsberg JS. Use of antithrombotic agents during pregnancy: the Seventh ACCP Conference on Antithrombotic and thrombolytic therapy. Chest 2004;163:627S-644S.
39. Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3 suppl):311S-337.
40. Pettila V, Leinonen P, Markkola A, Hiilesmaa V, Kaaja R. Postpartum bone mineral density in women treated for thromboprophylaxis with unfractionated heparin or LMW heparin. Thromb Haemost 2002;87(2):182-6.
41. Greer I, Hunt BJ. Low molecular weight heparin in pregnancy: current issues. Br J Haematol 2005;128:593-601.
42. Smith MP, Norris LA, Steer PJ, Savidge GF, Bonnar J. Tinzaparin sodium for thrombosis treatment and prevention during pregnancy. Am J Obstet Gynecol 2004;190:495-501.
43. Bates SM, Greer IA, Pabinger I, Sofaer S, Hirsh J, American College of Chest Physicians. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008;133(6 suppl):844S-886S.
44. Levine MN, Hirsh J, Gent M, et al. A randomized trial comparing activated thromboplastin time with heparin assay in patients with acute venous thromboembolism requiring large daily doses of heparin. Arch Intern Med 1994;154:49-56.
45. Wan S, Quinlan DJ, Agnelli G, Eikelboom JW. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation 2004;110:744-9.
46. Ahearn GS, Hadjiliadis MD, Govert JA, Tapson VF. Massive pulmonary embolism during pregnancy successfully treated with recombinant tissue plasminogen activator. Arch Intern Med 2002;162:1221-7.
47. Blättler W, Partsch H. Leg compression and ambulation is better than bed rest for the treatment of acute deep vein thrombosis. Int Angiol 2003;22:393-400.
48. Brandjes DP, Buller HR, Heijboer H, et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997;349:759-62.
49. Rodie VA, Thomson AJ, Stewart FM, et al. Low molecular weight heparin for the treatment of venous thromboembolism in pregnancy- case series. Br J Obstet Gynaecol 2002;109:1020-4.
50. Lee AY, Levine MN, Baker RI, et al., Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003;349:146-53.
51. Greer IA.Thrombosis in pregnancy: maternal and fetal issues. Lancet 1999;353:1258-65.
52. Kearon C, Hirsh J. Management of anticoagulation before and after elective surgery. N Engl J Med 1997;336:1506-11.
53. Becker DM, Philbrick JT, Selby JB. Inferior vena cava filters. Indications, safety, effectivemess. Arch Intern Med 1992;152(10): 1985-94.
54. Athanasoulis CA, Kaufman JA, Halpern EF, Waltman AC, Geller SC, Fan CM. Inferior vena caval filters: review of a 26-year single-center clinical experience. Radiology 2000;216(1):54-66.
55. Decousus H, Leizorovicz A, Pretn F, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prevention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med 1998;338(7):409-15.
56. Kawamata K, Chiba Y, Tanaka R, Higashi M, Nishigami K. Experience of temporary inferior vena caval filters inserted in the perinatal period to prevent pulmonary embolism in pregnant women with deep vein thrombosis. J Vasc Surg 2005;41(4):652-6.
57. Jamjute P, Reed N, Hinwood D. Use of inferior vena cava filters in thromboembolic disease during labor: case report with a literature review. J Matern Fetal Neonatal Med 2006;19(11):741-4.
58. Jacobsen AF, Skjeldestad FE, Sandset PM. Ante- and postnatal risk factors of venous thrombosis: a hospital-based case-control study. J Thromb Haemost 2008;6(6):905-12.
59. Simpson EL, Lawrenson RA, Nightingale AL, Farmer RDT. Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. Br J Obstet Gynaecol 2001;108:56-60.
60. RCOG. Reducing the risk of thrombosis and embolism during pregnancy and the puerperium. Green Top Guideline No 37. Royal College of obstetricians and Gynaecologists, London, 2009.
61. Scottish Intercollegiate Guidelines Network. Pregnancy and the puerperium. Scottish Intercollegiate Guidelines Network, Edinburgh, 2002.
62. Bates SM, Greer IA, Pabinger I, Sofaer S, Hirsh J. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133 (6 suppl):844S-886S.
63. Pabinger I, Grafenhofer H, Kyrle PA, et al. Temporary increase in the risk for recurrence during pregnancy in women with a history of venous thromboembolism. Blood 2002;100: 1060-2.
64. Brill-Edwards P, Ginsberg JS, for the Recurrence Of Clot In This Pregnancy (ROCIT) Study Group. Safety of withholding antepartum heparin in women with a previous episode of venous thromboembolism. N Engl J Med 2000;343:1439-44.
65. Pabinger I, Grafenhofer H, Kaider A, et al. Risk of pregnancyassociated recurrent venous thromboembolism in women with a history of venous thrombosis. J Thromb Haemost 2005;3:949-54.
66. Duhl AJ, Paidas MJ, Ural SH, et al. Antithrombotic therapy and pregnancy: consensus report and recommendations for prevention and treatment of venous thromboembolism and adverse pregnancy outcomes. Am J Obstet Gynecol 2007;197(5):457-21.
67. De Stefano V, Martinelli I, Rossi E, et al. The risk of recurrent venous thromboembolism in pregnancy and puerperium without antithrombotic prophylaxis. Br J Haematol 2006;135(3):386-91.
68. White RH, Chan WS, Zhou H, Ginsberg JS. Recurrent venous thromboembolism after pregnancy-associated versus unprovoked thromboembolism. Thromb Haemost 2008;100(2):246-52.
69. Jacobsen AF, Skjeldestad FE, Sandet PM. Incidence and risk patters of venous thromboemolism in pregnancy and puerperium - a register-based case-control study. Am J Ostet Gynecol 2008;198:223e.1-223e.7.
70. Royal College of Obstetricians and Gynaecologists. Air travel and pregnancy. Scientific Advisory Committee Opinion Paper 1. Royal College of Obstetricians and Gynaecologists, London, 2008.
71. Sia WW, Powrie RO, Cooper AB, et al. Incidence of deep vein thrombosis in women undergoing cesarean delivery. Thromb Res 2009;123(3):550-5.
72. Gerhardt A, Scharf RE, Beckman MW, et al. Prothrombin and factor V mutations in women with thrombosis during pregnancy and the puerperium. N Engl J Med 2000;342:374-80.
73. Greer IA. The challenge of thrombophilia in maternal-fetal medicine. N Engl J Med 2000;342:424-5.
74. McColl MD, Ellison J, Reid F, et al. Prothrombin 20210GA, MTHFR C677T mutations in women with venous thromboembolism associated with pregnancy. Br J Obstet Gynaecol 2000;107:565-9.
75. McColl MD, Walker ID, Greer IA. The role of inherited thrombophilia in venous thromboembolism associated with pregnancy. Br J Obstet Gynaecol 1999;75:387-8.
76. McLintock, North RA, Dekker G. Inherited thrombophilias: associated venous thromboembolism and obstetric complications. Curr Prob Obstet Gynecol Fertil 2001;24:109-52.
77. Conard J, Horellou MH, van Dreden P, Le Compte T, Samama M. Thrombosis in pregnancy and congenital deficiencies in AT III, protein C or protein S: study of 78 women. Thromb Haemost 1990;63:319-20.
78. Friederich PW, Sanson BJ, Simioni P, et al. Frequency of pregnancy- related venous thromboembolism in anticoagulant factor- deficient women: implications for prophylaxis. Arch Intern Med 1996;125:955-60.
79. Lim W, Eikelboom JW, Ginsberg J. Inherited thrombophilia and pregnancy associated thromboembolism. BMJ 2007;443: 1318-21.
80. Dizon-Towson D, Miller C, Sibai B, et al. The relationship of the factor V Leiden mutation and pregnancy outcomes for mother and fetus. Obstet Gynecol 2005;106:517-24.
81. Simioni P, Tormene D, Prandoni P, Girolami A. Pregnancy related recurrent events in thrombophilic women with previous venous thromboembolism. Thromb Haemost 2001;86:929.
82. Walker ID, Greaves M, Preston FE. British Society for Haematology Guideline. Investigation and management of heritable thrombophilia. Br J Haematol 2001;114:512-28.
83. Knight M, UKOSS. Antenatal pulmonary embolism: risk factors, management and outcomes. Br J Obstet Gynecol 2008;115(4):453-61.
84. Arya R, Shehata HA, Patel RK, et al. Internal jugular vein thrombosis following assisted conception therapy. Br J Haematol 2001;115:153-6.
85. Sanson BJ, Lensing AWA, Prins MH, et al. Safety of lowmolecular- weight heparin in pregnancy: a systematic review. Thromb Haemost 1999;81:668-72.
86. Ensom MHH, Stephenson MD. Low molecular weight heparins in pregnancy. Pharmacotherapy 1999;19:1013-25.
87. Lepercq J, Conard J, Borel-Derlon A, et al. Venous thromboembolism during pregnancy: a retrospective study of enoxaparin safety in 624 pregnancies. Br J Obstet Gynaecol 2001; 108(11):1134-40.
88. Pulmonary Embolism Prevention (PEP) Trial Collaborative Group. Prevention of pulmonary embolism and deep venous thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet 2000;355:1295-302.
89. Maybury H, Waugh JJ, Gornall AS, Pavord S,. There is a return to non-pregnant coagulation parameters after four not six weeks postpartum following spontaneous vaginal delivery. Obstet Med 2008;1:92-4.
90. Stein PD , Terrin ML, Hales CA, et al Clinical, laboratory, roentgenographic and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disase. Chest 1991;100(3):598-603.
91. Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med 2008;359:2025-33.
92. Pahde JK, Litmanovich D, Pedrosa I, Romero J, Bankier AA, Boiselle PM. Quality initiatives: imaging patients with suspected pulmonary embolism: what the radiologist needs to know. Radiographics 2009;29(3):639-54.
93. Bourjeily G, Rosene-Montella K. Venous thromboembolism in pregnancy. In: Pulmonary Problems in Pregnancy. Humana Press, New York, 2009.
94. Righini M, Perrier A, de Moerloose P, Bounameaux H. D-dimer for venous thromboembolism diagnosis: 20 years later. J Thromb Haemost 2008; 6(7):1059-71.
95. van Dongen CJ, van den Belt AG, Prins MH, Lensing AW. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database of Systematic Reviews, 2004;4: CD001100.
96. Dahlman TC. Osteoporotic fractures and the recurrence of thromboembolism during pregnancy and the puerperium in 184 women undergoing thromboprophylaxis with heparin. Am J Obstet Gynecol 1993;168(4):1265-70.
97. Le Templier G, Rodger MA. Heparin-induced osteoporosis and pregnancy. Curr Opin Pulm Med 2008;14(5):403-7.
98. Hassell K. Heparin-induced thrombocytopenia: diagnosis and management. Thromb Res 2008:123(suppl 1):S16-21.
99. Shields RC, McBane RD, Kuiper JD, Li H, Heit JA. Efficacy and safety of intravenous phytonadione (vitamin K1) in patients on long-term oral anticoagulant therapy. Mayo Clin Proc 2001;76(3):260-6.