PMID- 19289023
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20100701
LR  - 20211020
IS  - 1092-8464 (Print)
IS  - 1092-8464 (Linking)
VI  - 11
IP  - 2
DP  - 2009 Apr
TI  - Venous thromboembolism in pregnancy.
PG  - 104-13
AB  - Low molecular weight heparins (LMWHs) appear to be as safe and effective as 
      unfractionated heparin (UFH) for venous thromboembolic disease (VTED) treatment 
      or prophylaxis during pregnancy. Experience with other parenteral anticoagulant 
      drugs is very limited, and no alternative oral anticoagulants are available to 
      date. In addition to cost, challenges of long-term LMWH use during pregnancy that 
      have not been addressed by controlled clinical trials include a) ideal dosing as 
      pregnancy advances, b) the need for LMWH monitoring by anti-Xa activity levels, 
      and c) ideal therapeutic management as the delivery date nears. Because 
      therapeutic-intensity anticoagulation during pregnancy is challenging, many 
      practitioners favor a more "aggressive" approach toward VTED prophylaxis in women 
      perceived to be at very high risk of thrombosis during pregnancy. Best evidence 
      to date suggests that most women with thrombophilias or with a previous 
      "situational" VTED event probably do not require VTED prophylaxis antepartum, but 
      postpartum anticoagulation prophylaxis is recommended for a few weeks. For those 
      with a history of previous idiopathic VTED or VTED associated with "hormonal 
      challenge" (such as with contraceptive use or previous pregnancy), prophylaxis 
      beginning antepartum may be considered and discussed with the patient. Selected 
      cases of "severe" thrombophilia are probably best managed by initiation of 
      pharmacologic VTED prophylaxis antepartum. However, it must be emphasized that 
      data from prospective controlled clinical trials are lacking.
FAU - Villa-Forte Gomes, Marcelo P
AU  - Villa-Forte Gomes MP
AD  - Section of Vascular Medicine, Department of Cardiovascular Medicine, Heart and 
      Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-5, Cleveland, 
      OH 44195, USA. gomesm3@ccf.org
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Curr Treat Options Cardiovasc Med
JT  - Current treatment options in cardiovascular medicine
JID - 9815942
EDAT- 2009/03/18 09:00
MHDA- 2009/03/18 09:01
CRDT- 2009/03/18 09:00
PHST- 2009/03/18 09:00 [entrez]
PHST- 2009/03/18 09:00 [pubmed]
PHST- 2009/03/18 09:01 [medline]
AID - 10.1007/s11936-009-0011-y [doi]
PST - ppublish
SO  - Curr Treat Options Cardiovasc Med. 2009 Apr;11(2):104-13. doi: 
      10.1007/s11936-009-0011-y.