Management of venous thromboembolism in pregnancy. Issue 211 (March 2022) - Kalaitzopoulos, Dimitrios Rafail
Abstract: Venous thromboembolism (VTE) in pregnancy, consisting of deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major factor of maternal mortality. Several patient-specific risk factors along with the physiologic changes of pregnancy promote a state of hypercoagulability in pregnant women. Detailed assessment of all pregnant women can establish a risk profile that would guide clinical decisions, and balance potential therapeutic benefits with side effects. Differentiating between physiologic changes of pregnancy and symptoms of VTE can be challenging and warrants meticulous clinical evaluation. Timely and accurate diagnosis of VTE with proper imaging is essential for its management, and systemic anticoagulation remains the cornerstone of VTE prevention and therapy. Furthermore, advanced invasive treatment options such as inferior vena cava filters and thrombectomy can be considered for complex cases. Importantly, the risk of systemic anticoagulation should be balanced against the risk of VTE-associated morbidity and mortality for mother and fetus, and an informed decision should be made. In this review, we present an up-to-date overview of VTE management in pregnancy and the postpartum period. Highlights: Venous thromboembolism (VTE) comprises a major factor of maternal mortality. Critical clinical evaluation is warranted for efficient differential diagnosis between physiologic changes of pregnancy and VTE that is often challenging. Anticoagulation is the cornerstone of VTE therapy but more complex therapies can be utilized for individual cases with comorbidities.