PMID- 16551552
OWN - NLM
STAT- MEDLINE
DCOM- 20060522
LR  - 20200928
IS  - 1550-8579 (Print)
IS  - 1550-8579 (Linking)
VI  - 2 Suppl A
DP  - 2005
TI  - Venous thromboembolism and anticoagulant therapy in pregnancy.
PG  - S10-7
AB  - BACKGROUND: Venous thromboembolism (VTE) is a leading cause of maternal mortality 
      in western countries. Many of these deaths could be prevented by optimal 
      prophylaxis and management. OBJECTIVE: The aim of this study was to examine the 
      current literature to assess the risk of VTE in pregnant women and to identify 
      the most effective and safe anticoagulant therapy. METHODS: A search was 
      conducted using the major electronic databases of PubMed and MEDLINE 1996-October 
      2005 using the following key words: Pregnancy, venous thrombosis, thrombophilia, 
      prosthetic heart valves, anticoagulants, heparin, low-molecular-weight heparin, 
      coumarin, and warfarin. RESULTS: The common risk factors for VTE during pregnancy 
      are age >35 years, obesity, operative delivery, thrombophilia, and a family or 
      personal history of VTE. Coumarins are unsuitable for use during pregnancy 
      because of embryopathy and risk of fetal bleeding. Low-molecular-weight heparins 
      (LMWHs), such as enoxaparin and dalteparin, are safer and more convenient than 
      unfractionated heparin (UFH). LMWH is now the agent of choice for pharmacologic 
      thromboprophylaxis and treatment of VTE during pregnancy. Women with a suspected 
      VTE should receive anticoagulant therapy until an objective diagnostic test is 
      performed, unless there is a clear contraindication to anticoagulation. If a VTE 
      is confirmed, anticoagulant treatment should be continued throughout pregnancy. 
      These patients usually, require at least 6 months of anticoagulation, and 
      treatment should be continued until at least 6 weeks postpartum. Management of 
      women with prosthetic heart valves in pregnancy is controversial; while coumarin 
      treatment is more effective than UFH for thromboprophylaxis in the mother, UFH is 
      associated with a better outcome for the fetus. Coumarin embryopathy can be 
      avoided if heparin is substituted by 6 weeks' gestation. The limited data on LMWH 
      in women with prosthetic heart valves suggest that it compares favorably with 
      UFH. CONCLUSIONS: LMWH is now the anticoagulant of choice for the treatment and 
      prevention of VTE in pregnancy. However, the management of women with prosthetic 
      heart valves requiring anticoagulation in pregnancy remains controversial as 
      coumarins appear safer for the mother, but heparin is associated with less fetal 
      morbidity and data on LMWH are limited.
FAU - Greer, Ian A
AU  - Greer IA
AD  - University of Glasgow, Division of Developmental Medicine, Maternal and 
      Reproductive Medicine, Glasgow Royal Infirmary, Scotland, UK. 
      I.A.Greer@clinmed.gla.ac.uk
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Gend Med
JT  - Gender medicine
JID - 101225178
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Adult
MH  - Anticoagulants/*therapeutic use
MH  - Female
MH  - Fibrinolytic Agents/therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Pregnancy
MH  - Pregnancy Complications, Hematologic/*drug therapy/prevention & control
MH  - Prenatal Care/methods
MH  - Pulmonary Embolism/*drug therapy/prevention & control
MH  - Risk Factors
MH  - Venous Thrombosis/*drug therapy/prevention & control
MH  - Women's Health
RF  - 52
EDAT- 2006/03/23 09:00
MHDA- 2006/05/23 09:00
CRDT- 2006/03/23 09:00
PHST- 2005/11/07 00:00 [accepted]
PHST- 2006/03/23 09:00 [pubmed]
PHST- 2006/05/23 09:00 [medline]
PHST- 2006/03/23 09:00 [entrez]
AID - S1550-8579(05)80060-9 [pii]
AID - 10.1016/s1550-8579(05)80060-9 [doi]
PST - ppublish
SO  - Gend Med. 2005;2 Suppl A:S10-7. doi: 10.1016/s1550-8579(05)80060-9.