PMID- 12871278
OWN - NLM
STAT- MEDLINE
DCOM- 20030926
LR  - 20230829
IS  - 1538-7933 (Print)
IS  - 1538-7836 (Linking)
VI  - 1
IP  - 7
DP  - 2003 Jul
TI  - Management of venous thromboembolism during pregnancy.
PG  - 1435-42
AB  - The incidence of venous thromboembolism (VTE) probably increases 2-4-fold in 
      pregnancy and is higher after a caesarean section than after vaginal delivery. 
      Management of VTE in pregnancy is challenging. Many diagnostic tests are less 
      accurate in pregnant than in non-pregnant patients and some radiologic procedures 
      expose the fetus to ionizing radiation, although this can be reduced by taking 
      appropriate precautions. Compression ultrasonography (CUS) is the test of choice 
      for deep vein thrombosis (DVT), whereas for PE, V/Q lung scan is the first-line 
      test, followed by CUS if the results are non-diagnostic. Anticoagulants that have 
      been evaluated for the prevention and treatment of VTE in pregnancy include 
      heparin and heparin compounds, and coumarin derivatives. When determining the 
      optimal treatment regimens, it is important to consider: (i) the safety of the 
      drug for the fetus and mother; (ii) the efficacy of the regimen; and (iii) the 
      dose regimens for acute and secondary treatment, and during delivery and 
      postpartum. Heparins are safer than coumarins for the fetus, as they do not cross 
      the placental barrier. Heparins, particularly unfractionated heparin (UFH) and 
      low molecular weight heparin (LMWH) tend also to be safer for the mother than 
      other compounds. Of the two, LMWHs, although more expensive, are associated with 
      lower rates of bleeding complications, and heparin-induced thrombocytopenia and 
      osteoporosis, than UFH, and should therefore be the treatment of choice in VTE 
      during pregnancy. Patients with prior VTE or a hypercoagulable state have an 
      increased risk of VTE during pregnancy. Depending on the presence of one or both 
      of these factors, clinical surveillance, with anticoagulant treatment where 
      necessary, is recommended.
FAU - Ginsberg, J S
AU  - Ginsberg JS
AD  - Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 
      dinningf@mcmaster.ca
FAU - Bates, S M
AU  - Bates SM
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - Female
MH  - Humans
MH  - Pregnancy
MH  - Pregnancy Complications, Cardiovascular/therapy
MH  - Risk
MH  - Thromboembolism/*diagnosis/*therapy
MH  - Venous Thrombosis/*diagnosis/therapy
RF  - 67
EDAT- 2003/07/23 05:00
MHDA- 2003/09/27 05:00
CRDT- 2003/07/23 05:00
PHST- 2003/07/23 05:00 [pubmed]
PHST- 2003/09/27 05:00 [medline]
PHST- 2003/07/23 05:00 [entrez]
AID - S1538-7836(22)15107-X [pii]
AID - 10.1046/j.1538-7836.2003.00307.x [doi]
PST - ppublish
SO  - J Thromb Haemost. 2003 Jul;1(7):1435-42. doi: 10.1046/j.1538-7836.2003.00307.x.