122 - Venous Thromboembolism in Pregnancy
Autor(s): L. Spiezia, M. Bon, P. Simioni
Issue: RIMeL - IJLaM, Vol. 6, N. 2, 2010 (MAF Servizi srl ed.)
Page(s): 122-125
During pregnancy, the risk of venous thromboembolism (VTE) can increase 4- to 5-folds as compared to non-pregnant women. This predisposition to thrombosis is the result of the hypercoagulable state of pregnancy related to the increase of procoagulant factors and the decrease of physiological anticoagulants. Several factors account for the development of VTE in pregnancy. Virchow’s classic triad associated with the pathogenesis of thrombosis, including stasis, hypercoagulability, and vascular injury, is present during the whole pregnancy. In addition, pregnant patients with acquired or inherited thrombophilic defects are at particularly higher risk for VTE. Clinical symptoms of deep venous thrombosis (DVT) may be elusive and often difficult to be distinguished from gestational edema. Venous compression ultrasonography (CUS) is the diagnostic test of choice meanwhile the tests of choice for the diagnosis of pulmonary embolism (PE) are the ventilation/perfusion lung scinti-scan or computed tomographic pulmonary angiography (CTPA). Therapy of established VTE during pregnancy consists of therapeutic doses of unfractionated heparin or low-molecular-weight heparin (LMWH), generally administered throughout pregnancy and post-partum for an overall period of at least six months after the thrombotic event. An unresolved issue includes the optimal dose of LMWH therapy during pregnancy complicated by VTE. Prevention of VTE remains the goal for the clinician and is related to a careful evaluation of the true risk of VTE in pregnant patients especially those with previous VTE and/or thrombophilia. This article provides a brief overview of the pathophysiology, diagnosis, treatment and prevention of VTE in pregnancy and refers the reader to recent evidence based guidelines.