Roza Chaireti

By Roza Chaireti and Katarina Bremme

The naturally hypercoagulable state occurring during pregnancy and anatomical changes and changes in the plasma volume are the main reasons for the increased risk of venous thromboembolism (VTE) during pregnancy and puerperium. This risk is particularly enhanced in the presence of thrombophilia and a previous history of VTE. The cornerstone for treating and preventing VTE is low molecular weight heparin (LMWH). There is currently no consensus on the dosing and the need for monitoring treatment with LMWH, and varying protocols are used in different clinics. The risk models used to stratify the risk for recurrence are based on the presence of factors such as previous VTE, familial history and thrombophilia and lead to decisions on the dosing and the duration of thromboprophylaxis. Treatment with LMWH is considered safe and effective, with low incidence of adverse effects (bleeding, osteoporosis, etc.) and recurrence of VTE. The use of direct oral anticoagulants is currently not recommended in this setting, but case series have not indicated increased embryopathy. The lack of international guidelines and large studies underlines the need for collaboration in order to further improve outcomes and patient safety.

Part of the book: Embolic Diseases