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What are the updated recommendations for the diagnosis and management of venous thromboembolism in pregnancy?
What are the updated recommendations for the diagnosis and management of venous thromboembolism in pregnancy?
This review highlights that low-molecular-weight heparin remains the standard of care for VTE in pregnancy, while DOACs are contraindicated, and outlines preferred diagnostic imaging modalities.
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Supports LMWH and preferred imaging for pregnancy VTE; leaves open need for randomized confirmation.
Acute venous thromboembolism poses significant problems in pregnancy, a time when objective diagnosis and prompt treatment are essential. Events can occur at any stage in pregnancy, but the period of greatest risk is in the weeks after delivery. Ultrasound venography remains the diagnostic technique of choice for deep venous thrombosis. For pulmonary thromboembolism, ventilation perfusion lung scan is usually preferred more than computerized tomography pulmonary angiography because of the lower maternal radiation dose and the lower prevalence of coexisting pulmonary problems. Low-molecular-weight heparin is the agent of choice for treatment of venous thromboembolism in pregnancy, and treatment should be provided for a minimum of 3 months and for at least 6 weeks after delivery. New anticoagulant agents such as dabigatran, rivaroxaban, or apixaban are not recommended for use in pregnancy.
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Ian A. Greer (2012) studied this question.
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