The prevention and treatment of venous thromboembolism in pregnancy

INTRODUCTION: Venous thromboembolism (VTE) in pregnancy represents an important cause of maternal morbidity and mortality in developed countries, with an incidence of 0.5-2.2 per 1000 pregnancies. In addition to hemostatic changes occurring during normal pregnancy, several risk factors have been identified. Thus, a variety of clinical conditions as well as fetal and maternal risks linked to a possible anticoagulant therapy should be considered for the management of VTE during pregnancy. Unfortunately, there is a paucity of high-quality evidence from randomized trials in this field, and current recommendations are based on observational studies or evidence gathered from studies in the non-pregnant population. Areas covered: The purpose of this review is to summarize available evidence on the prevention and treatment of pregnancy-related VTE. Expert commentary: Although the optimal prophylactic and therapeutic dosage has not yet been established, low-molecular-weight heparin (LMWH) represents the most efficacious and safe anticoagulant during pregnancy. Thus, after an accurate risk stratification of women during pregnancy and puerperium, LMWH should be recommended to women at risk for VTE and to those ones suffering from an acute event.