Key result
Individualized multidisciplinary care including anticoagulation, antithrombin concentrate, and postpartum IVC filter placement resulted in successful delivery and management of massive DVT.
Why the study?
Literature regarding the management of thrombus refractory to first-line treatment during pregnancy is limited, especially in the context of thrombophilia.
Case Report (n=1)
Highlights a successful multidisciplinary approach for managing refractory DVT in a pregnant patient with antithrombin deficiency and May-Thurner syndrome.
May support individualized multidisciplinary care for refractory DVT in antithrombin-deficient pregnancy; leaves open need for prospective studies before broader adoption.
Literature regarding the management of thrombus refractory to first-line treatment in the setting of pregnancy is limited, and management is made even more complicated in the context of thrombophilia. This case reviews the management of a patient with antithrombin deficiency who developed a massive thrombus during pregnancy, which was complicated by May-Thurner syndrome, lack of improvement with heparin, and preterm labor. The patient received multidisciplinary care throughout the pregnancy. At 35 weeks, anticoagulation was paused as she underwent induction of labor and delivery followed by postpartum placement of inferior vena cava filter and restarting heparin. Successful management of our pregnant patient with thrombus refractory to heparin hinged on individualized treatment for medical optimization with anticoagulation and antithrombin concentrate prior to labor followed by immediate postpartum placement of inferior vena cava filter.
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Stevens-Haas et al. (2022) conducted a case report in Deep venous thrombosis in pregnancy with antithrombin deficiency and May-Thurner syndrome (n=1). Multidisciplinary management (anticoagulation, antithrombin concentrate, thrombectomy, postpartum IVC filter) was evaluated on Clinical outcome (successful delivery and DVT management). Individualized multidisciplinary care including anticoagulation, antithrombin concentrate, and postpartum IVC filter placement resulted in successful delivery and management of massive DVT.
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