Contemporary best practice in the management of pulmonary embolism during pregnancy

被引:26
作者
Wiegers, Hanke M. G. [1 ]
Middeldorp, Saskia [1 ]
机构
[1] Univ Amsterdam, Dept Vasc Med, Amsterdam Cardiovasc Sci, Amsterdam UMC, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands
关键词
anticoagulants; clinical prediction rules; D-dimer; deep vein thrombosis; low-molecular-weight heparin; pregnancy; pulmonary embolism; venous thromboembolism; DIRECT ORAL ANTICOAGULANTS; RECURRENT VENOUS THROMBOEMBOLISM; MOLECULAR-WEIGHT HEPARIN; CHILDBEARING POTENTIAL GUIDANCE; RISK-FACTORS; D-DIMER; POSTTHROMBOTIC SYNDROME; POSTPARTUM HEMORRHAGE; DIAGNOSTIC MANAGEMENT; WOMEN;
D O I
10.1177/1753466620914222
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Approximately 1-2 per 1000 pregnancies are complicated by venous thromboembolism (VTE). VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE) and the diagnostic management of pregnancy-related VTE is challenging. Current guidelines vary greatly in their approach to diagnosing PE in pregnancy as they base their recommendations on scarce and weak evidence. The pregnancy-adapted YEARS diagnostic algorithm is well tolerated and is the most efficient diagnostic algorithm for pregnant women with suspected PE, with 39% of women not requiring computed tomographic pulmonary angiography. Low-molecular-weight heparin is the first-choice anticoagulant treatment in pregnancy and should be continued until 6 weeks postpartum and for a minimum of 3 months. Direct oral anticoagulants should be avoided in women who want to breastfeed. Management of delivery needs a multidisciplinary approach in order to decide on an optimal delivery plan. Neuraxial analgesia can be given in most patients, provided time windows since last low-molecular-weight heparin dose are respected. Women with a history of VTE are at risk of recurrence during pregnancy and in the postpartum period. Therefore, in most women with a history of VTE, thromboprophylaxis in subsequent pregnancies is indicated. The reviews of this paper are available via the supplemental material section.
引用
收藏
页数:20
相关论文
共 79 条
[1]  
[Anonymous], THROMB DIS PREG PUER
[2]  
[Anonymous], 2017, BJOG-INT J OBSTET GY, V124, pe106, DOI DOI 10.1111/1471-0528.14178
[3]   Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study [J].
Baglin, T ;
Luddington, R ;
Brown, K ;
Baglin, C .
LANCET, 2003, 362 (9383) :523-526
[4]   Postpartum haemorrhage in nulliparous women:: incidence and risk factors in low and high risk women -: A Dutch population-based cohort study on standard (≥500 ml) and severe (≥1000 ml) postpartum haemorrhage [J].
Bais, JMJ ;
Eskes, M ;
Pel, M ;
Bonsel, GJ ;
Bleker, OP .
EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY, 2004, 115 (02) :166-172
[5]   High rate of skin complications due to low-molecular-weight heparins in pregnant women [J].
Bank, I ;
Libourel, EJ ;
Middeldorp, S ;
Van der Meer, J ;
Büller, HR .
JOURNAL OF THROMBOSIS AND HAEMOSTASIS, 2003, 1 (04) :859-861
[6]   American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy [J].
Bates, Shannon M. ;
Rajasekhar, Anita ;
Middeldorp, Saskia ;
McLintock, Claire ;
Rodger, Marc A. ;
James, Andra H. ;
Vazquez, Sara R. ;
Greer, Ian A. ;
Riva, John J. ;
Bhatt, Meha ;
Schwab, Nicole ;
Barrett, Danielle ;
LaHaye, Andrea ;
Rochwerg, Bram .
BLOOD ADVANCES, 2018, 2 (22) :3317-3359
[7]   VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [J].
Bates, Shannon M. ;
Greer, Ian A. ;
Middeldorp, Saskia ;
Veenstra, David L. ;
Prabulos, Anne-Marie ;
Vandvik, Per Olav .
CHEST, 2012, 141 (02) :E691S-E736S
[8]   Pregnancy outcome in patients exposed to direct oral anticoagulants - and the challenge of event reporting [J].
Beyer-Westendorf, Jan ;
Michalski, Franziska ;
Tittl, Luise ;
Middeldorp, Saskia ;
Cohen, Hannah ;
Kadir, Rezan Abdul ;
Arachchillage, Deepa Jayakody ;
Arya, Roopen ;
Ay, Cihan ;
Marten, Sandra .
THROMBOSIS AND HAEMOSTASIS, 2016, 116 (04) :651-658
[9]  
Bistervels I, 2019, RES PR THROMB HAEMOS, V3
[10]   Low-molecular-weight heparin to prevent recurrent venous thromboembolism in pregnancy: Rationale and design of the High-low study, a randomised trial of two doses [J].
Bleker, Suzanne M. ;
Buchmuller, Andrea ;
Chauleur, Celine ;
Ainle, Fionnuala Ni ;
Donnelly, Jennifer ;
Verhamme, Peter ;
Jacobsen, Anne Flem ;
Ganzevoort, Wessel ;
Prins, Martin ;
Beyer-Westendorf, Jan ;
DeSancho, Maria ;
Konstantinides, Stavros ;
Pabinger, Ingrid ;
Rodger, Marc ;
Decousus, Herve ;
Middeldorp, Saskia .
THROMBOSIS RESEARCH, 2016, 144 :62-68