Key result
Systemic thrombolysis for VTE in pregnancy had maternal and fetal complication rates of 4.40% and 1.65%, versus 14.75% and 5.2% for catheter-directed thrombolysis, and 0% for mechanical thrombectomy.
Why the study?
What are the maternal and fetal complication rates associated with thrombolysis or mechanical thrombectomy for venous thromboembolism during pregnancy?
What are the maternal and fetal complication rates associated with thrombolysis or mechanical thrombectomy for venous thromboembolism during pregnancy?
Systemic thrombolysis and mechanical thrombectomy appear to have low maternal and fetal complication rates for treating limb- or life-threatening VTE in pregnancy, whereas catheter-directed thrombolysis may carry higher risks.
Limited case reports describe thrombolysis for VTE in pregnancy; leaves open need for prospective data before clinical adoption.
BACKGROUND: Pregnancy is a hypercoagulable state, conferring an increased risk of venous thromboembolism (VTE). However, treatment algorithms for deep venous thrombosis and pulmonary embolism are based on studies of nonpregnant patients. METHODS: A literature review of cases in which thrombolysis was used for the treatment of VTE during pregnancy was conducted using the PubMed (National Institutes of Health) database. RESULTS: A PubMed database search of English language articles for reports of thrombolysis for the treatment of VTE in pregnancy identified 215 cases, including 183 cases of systemic thrombolysis, 19 cases of catheter-directed thrombolysis, and 13 cases of mechanical thrombectomy. For systemic thrombolysis, the maternal complication rate was 4.40% and the fetal complication rate was 1.65%. For catheter-directed thrombolysis, the maternal complication rate was 14.75% and the fetal complication rate was 5.2%. In cases of mechanical thrombectomy, there were no reported maternal or fetal complications. CONCLUSIONS: Although conservative strategies are preferred in pregnancy, thrombolysis is an adjunct for limb or life-threatening VTE. Review of past reports suggests low rates of maternal and fetal complications following systemic thrombolysis and mechanical thrombectomy but higher rates of complications after catheter-directed thrombolysis in the treatment of VTE during pregnancy.
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Ho et al. (2018) conducted a review in Venous thromboembolism during pregnancy (n=215). Thrombolysis (systemic, catheter-directed, or mechanical thrombectomy) was evaluated on Maternal and fetal complication rates. Systemic thrombolysis for VTE in pregnancy had maternal and fetal complication rates of 4.40% and 1.65%, versus 14.75% and 5.2% for catheter-directed thrombolysis, and 0% for mechanical thrombectomy.
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