PMID- 15383488
OWN - NLM
STAT- MEDLINE
DCOM- 20041026
LR  - 20171116
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 126
IP  - 3 Suppl
DP  - 2004 Sep
TI  - Use of antithrombotic agents during pregnancy: the Seventh ACCP Conference on 
      Antithrombotic and Thrombolytic Therapy.
PG  - 627S-644S
AB  - This chapter about the use of antithrombotic agents during pregnancy is part of 
      the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence 
      Based Guidelines. Grade 1 recommendations are strong and indicate that the 
      benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that 
      individual patients' values may lead to different choices (for a full 
      understanding of the grading see Guyatt et al, CHEST 2004; 126:179S-187S). Among 
      the key recommendations in this chapter are the following: for women requiring 
      long-term vitamin K antagonist therapy who are attempting pregnancy, we suggest 
      performing frequent pregnancy tests and substituting unfractionated heparin (UFH) 
      or low molecular weight heparin (LMWH) for warfarin when pregnancy is achieved 
      (Grade 2C). In women with acute venous thromboembolism (VTE), we recommend 
      adjusted-dose LMWH throughout pregnancy or IV UFH for at least 5 days, followed 
      by adjusted-dose UFH or LMWH for the remainder of the pregnancy and at least 6 
      weeks postpartum (Grade 1C+). In patients with a single episode of VTE associated 
      with a transient risk factor that is no longer present, we recommend antepartum 
      clinical surveillance and postpartum anticoagulants (Grade 1C). In patients with 
      a single episode of VTE and thrombophilia or strong family history of thrombosis 
      and not receiving long-term anticoagulants, we suggest antepartum prophylactic or 
      intermediate-dose LMWH or minidose or moderate-dose UFH, plus postpartum 
      anticoagulants (Grade 2C). In patients with multiple (two or more) episodes of 
      VTE and/or women receiving long-term anticoagulants, we suggest antepartum 
      adjusted-dose UFH or adjusted-dose LMWH followed by long-term anticoagulants 
      postpartum (Grade 2C). For pregnant patients with antiphospholipid antibodies 
      (APLAs) and a history of two or more early pregnancy losses or one or more late 
      pregnancy losses, preeclampsia, intrauterine growth retardation, or abruption, we 
      suggest antepartum aspirin plus minidose or moderate-dose UFH or prophylactic 
      LMWH (Grade 2B). We suggest one of the following approaches for women with APLAs 
      without prior VTE or pregnancy loss: surveillance, minidose heparin, prophylactic 
      LMWH, and/or low-dose aspirin, 75 to 325 mg/d (all Grade 2C). In women with 
      prosthetic heart valves, we recommend adjusted-dose bid LMWH throughout pregnancy 
      (Grade 1C), aggressive adjusted-dose UFH throughout pregnancy (Grade 1C), or UFH 
      or LMWH until the thirteenth week and then change to warfarin until the middle of 
      the third trimester before restarting UFH or LMWH (Grade 1C). In high-risk women 
      with prosthetic heart valves, we suggest the addition of low-dose aspirin, 75 to 
      162 mg/d (Grade 2C).
FAU - Bates, Shannon M
AU  - Bates SM
AD  - McMaster University Medical Center, 1200 Main St West, Hamilton, ON L8N 325.
FAU - Greer, Ian A
AU  - Greer IA
FAU - Hirsh, Jack
AU  - Hirsh J
FAU - Ginsberg, Jeffrey S
AU  - Ginsberg JS
LA  - eng
PT  - Comparative Study
PT  - Guideline
PT  - Journal Article
PT  - Practice Guideline
PT  - Review
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Contraindications
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Evidence-Based Medicine
MH  - Female
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Heparin/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/therapeutic use
MH  - Humans
MH  - Pregnancy
MH  - Pregnancy Complications/blood/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Risk Assessment
MH  - Thromboembolism/blood/*drug therapy
MH  - *Thrombolytic Therapy
RF  - 119
EDAT- 2004/09/24 05:00
MHDA- 2004/10/27 09:00
CRDT- 2004/09/24 05:00
PHST- 2004/09/24 05:00 [pubmed]
PHST- 2004/10/27 09:00 [medline]
PHST- 2004/09/24 05:00 [entrez]
AID - S0012-3692(15)31507-5 [pii]
AID - 10.1378/chest.126.3_suppl.627S [doi]
PST - ppublish
SO  - Chest. 2004 Sep;126(3 Suppl):627S-644S. doi: 10.1378/chest.126.3_suppl.627S.