Cómo citar
1.
Camacho Solís AE, Méndez Zamora AM, Martín Zamora AC. Eventos tromboembólicos y el embarazo: actualización en anticoagulación en mujeres embarazadas. Rev.méd.sinerg. [Internet]. 1 de mayo de 2019 [citado 27 de diciembre de 2024];4(5):77 - 88. Disponible en: https://revistamedicasinergia.com/index.php/rms/article/view/210
Resumen
El embarazo se asocia a múltiples cambios fisiológicos y anatómicos que llevan a un estado protrombótico. Este estado incrementa 5 veces el riesgo de tromboembolismo venoso. Además, durante el periodo de gestación y puerperio existen otras condiciones, independientes o relacionadas con el embarazo, en las cuales la tromboprofilaxis farmacológica o la anticoagulación están indicadas. El iniciar la terapia anticoagulante en la mujer embarazada implica un balance de riesgos y beneficios para la madre y el feto así como consideraciones especiales según el tiempo de gestación. La heparina de bajo peso molecular es el tratamiento de elección en la mayoría de las indicaciones, sin embargo, existen casos en los que la warfarina o los anticoagulantes orales directos son de utilidad y están indicados como primera línea.
Palabras clave
trombosis. tromboembolismo venoso. embarazo. anticoagulantes. heparina. warfarina.
Citas
1. lshawabkeh L, Econocmy KE, Valente AM. Anticoagulation During Pregnancy: Evolving Strategies With a Focus on Mechanical Valves. J Am Coll Cardiol 2016; 68(16): 1804-1813. https://doi.org/10.1016/j.jacc.2016.06.076
2. Gibson PS, Powrie R. Anticoagulants and pregnancy: When are they safe? Cleve Clin J Med 2009; 76(2): 113-27. https://doi.org/10.3949/ccjm.75a.072272
3. American College of Obstetricians and Gynecologists. Thromboembolism in pregnancy. ACOG Practice Bulletin No. 196. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018; 132: e1-e17. https://doi.org/10.1097/AOG.0000000000002706
4. Sucker C, Zotz R. Prophylaxis and treatment of venous thrombosis and pulmonary embolism in pregnancy. Reviews in Vascular Medicine. 2015; 3(2): 24-30. https://doi.org/10.1016/j.rvm.2015.05.003
5. Scheres LJJ, Bistervels IM, Middeldorp S. Everything the clinician needs to know about evidence-based anticoagulation in pregnancy. Blood Rev. 2019; 33: 82-97 https://doi.org/10.1016/j.blre.2018.08.001
6. Scheres LJJ, Bistervels IM, Middeldorp S . Everything the clinician needs to know about evidence-based anticoagulation in pregnancy. Blood Rev. 2019; 33:82-97. https://doi.org/10.1016/j.blre.2018.08.00
7. Lim A, Samarage A, Lim B. Venous thromboembolism in pregnancy. Obstetrics, Gynaecology & Reproductive Medicine. 2016; 26(5): 133-139. https://doi.org/10.1016/j.ogrm.2016.02.005
8. Fogerty AE. Challenges of Anticoagulation Therapy in Pregnancy. Curr Treat Options Cardio Med. 2017; 19(10): 1-13. https://doi.org/10.1007/s11936-017-0575-x
9. Yarrington CD, Valente AM, Economy KE. Cardiovascular management in pregnancy: antithrombotic agents and antiplatelet agents. Circulation. 2015; 132: 1354-1364. https://doi.org/10.1161/CIRCULATIONAHA.114.003902
10. Ziakas PD, Pavlou M, Voulgarelis M. Heparin treatment in antiphospholipid syndrome with recurrent pregnancy loss: a systematic review and meta-analysis. Obstet Gynecol. 2010; 115(6): 1256-1262. https://doi.org/10.1097/AOG.0b013e3181deba40
11. Antovic A, Sennstrom M, Bremme K, Svenungsson E. Obstetric antiphospholipid syndrome. Lupus Sci Med. 2018; 5(1): e000197. https://doi.org/10.1136/lupus-2016-000197
12. Ferreira J, Wipf J. Pharmacologic Therapies in Anticoagulation. Medical Clinics of North America. 2016; 100(4): 695-718. https://doi.org/10.1016/j.mcna.2016.03.007
13. Breen K. Anticoagulation treatment. Medicine. 2017; 45(4): 239-243. https://doi.org/10.1016/j.mpmed.2017.01.010
14. Hogg K, Weitz J. Goodman y Gilman: The Pharmacological Basis of Therapeutics. 13th edition. Blood coagulation and Anticoagulant, Fibrinolytic, and Antiplatlet Drugs. New York.: McGraw-Hill; c2018: 592-593 p.
15. Blickstein D, Blickstein I. The risk of fetal loss associated with Warfarin anticoagulation. Int J Gynaecol Obstet 2002; 78(3): 221-225. https://doi.org/10.1016/S0020-7292(02)00186-8
16. Richardson A, Shah S, Harris C, McCulloch G, Antoun P. Anticoagulation for the Pregnant Patient with Mechanical Heart Valve, No Perfect Therapy: Review of Guidelines for Anticoagulation in the Pregnant Patient. Case Rep Cardiol. 2017; 2017: ID3090273. https://doi.org/10.1155/2017/3090273
17. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, et al. 2017 AHA/ACC Focused UPdate of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on ClinIcal Practice Guidelines. Circulation. 2017; 135(25): e1159-e1195. https://doi.org/10.1161/CIR.0000000000000503
18. Cohen H, Arachchillage DR, Middeldorp S, Beyer-Westendorf J, Abdul-Kadir R. Management of direct oral anticoagulants in women of childbearing potential: guidance from the SSC of the ISTH. J Thromb Haemost. 2016; 14(8): 1673-1676. https://doi.org/10.1111/jth.13366
19. Beyer-Westendorf J, Michalski F, Tittl L, Middeldorp S, Cohen H, Abdul Kadir R, et al. Pregnancy outcome in patients exposed to direct oral anticoagulants-and the challenge of event reporting. Thromb Haemost. 2016; 116(4): 651-658. https://doi.org/10.1160/TH16-04-0305
20. DeCarolis S, di Pasquo RE, Del Sordo G, Buonomo A, Schiavino D, Lanzone A, et al. Fondaparinux in pregnancy: could it be a safe option? A review of the literature. Thromb Res. 2015; 135(6): 1049-1051. https://doi.org/10.1016/j.thromres.2015.04.001
21. Mauermann E et al. Heparin-induced thrombocytopenia in pregnancy: an interdisciplinary challenge-a case report and literature review. Int J Obstet Anesth. 2016; 26: 79-82. https://doi.org/10.1016/j.ijoa.2015.11.009
2. Gibson PS, Powrie R. Anticoagulants and pregnancy: When are they safe? Cleve Clin J Med 2009; 76(2): 113-27. https://doi.org/10.3949/ccjm.75a.072272
3. American College of Obstetricians and Gynecologists. Thromboembolism in pregnancy. ACOG Practice Bulletin No. 196. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018; 132: e1-e17. https://doi.org/10.1097/AOG.0000000000002706
4. Sucker C, Zotz R. Prophylaxis and treatment of venous thrombosis and pulmonary embolism in pregnancy. Reviews in Vascular Medicine. 2015; 3(2): 24-30. https://doi.org/10.1016/j.rvm.2015.05.003
5. Scheres LJJ, Bistervels IM, Middeldorp S. Everything the clinician needs to know about evidence-based anticoagulation in pregnancy. Blood Rev. 2019; 33: 82-97 https://doi.org/10.1016/j.blre.2018.08.001
6. Scheres LJJ, Bistervels IM, Middeldorp S . Everything the clinician needs to know about evidence-based anticoagulation in pregnancy. Blood Rev. 2019; 33:82-97. https://doi.org/10.1016/j.blre.2018.08.00
7. Lim A, Samarage A, Lim B. Venous thromboembolism in pregnancy. Obstetrics, Gynaecology & Reproductive Medicine. 2016; 26(5): 133-139. https://doi.org/10.1016/j.ogrm.2016.02.005
8. Fogerty AE. Challenges of Anticoagulation Therapy in Pregnancy. Curr Treat Options Cardio Med. 2017; 19(10): 1-13. https://doi.org/10.1007/s11936-017-0575-x
9. Yarrington CD, Valente AM, Economy KE. Cardiovascular management in pregnancy: antithrombotic agents and antiplatelet agents. Circulation. 2015; 132: 1354-1364. https://doi.org/10.1161/CIRCULATIONAHA.114.003902
10. Ziakas PD, Pavlou M, Voulgarelis M. Heparin treatment in antiphospholipid syndrome with recurrent pregnancy loss: a systematic review and meta-analysis. Obstet Gynecol. 2010; 115(6): 1256-1262. https://doi.org/10.1097/AOG.0b013e3181deba40
11. Antovic A, Sennstrom M, Bremme K, Svenungsson E. Obstetric antiphospholipid syndrome. Lupus Sci Med. 2018; 5(1): e000197. https://doi.org/10.1136/lupus-2016-000197
12. Ferreira J, Wipf J. Pharmacologic Therapies in Anticoagulation. Medical Clinics of North America. 2016; 100(4): 695-718. https://doi.org/10.1016/j.mcna.2016.03.007
13. Breen K. Anticoagulation treatment. Medicine. 2017; 45(4): 239-243. https://doi.org/10.1016/j.mpmed.2017.01.010
14. Hogg K, Weitz J. Goodman y Gilman: The Pharmacological Basis of Therapeutics. 13th edition. Blood coagulation and Anticoagulant, Fibrinolytic, and Antiplatlet Drugs. New York.: McGraw-Hill; c2018: 592-593 p.
15. Blickstein D, Blickstein I. The risk of fetal loss associated with Warfarin anticoagulation. Int J Gynaecol Obstet 2002; 78(3): 221-225. https://doi.org/10.1016/S0020-7292(02)00186-8
16. Richardson A, Shah S, Harris C, McCulloch G, Antoun P. Anticoagulation for the Pregnant Patient with Mechanical Heart Valve, No Perfect Therapy: Review of Guidelines for Anticoagulation in the Pregnant Patient. Case Rep Cardiol. 2017; 2017: ID3090273. https://doi.org/10.1155/2017/3090273
17. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, et al. 2017 AHA/ACC Focused UPdate of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on ClinIcal Practice Guidelines. Circulation. 2017; 135(25): e1159-e1195. https://doi.org/10.1161/CIR.0000000000000503
18. Cohen H, Arachchillage DR, Middeldorp S, Beyer-Westendorf J, Abdul-Kadir R. Management of direct oral anticoagulants in women of childbearing potential: guidance from the SSC of the ISTH. J Thromb Haemost. 2016; 14(8): 1673-1676. https://doi.org/10.1111/jth.13366
19. Beyer-Westendorf J, Michalski F, Tittl L, Middeldorp S, Cohen H, Abdul Kadir R, et al. Pregnancy outcome in patients exposed to direct oral anticoagulants-and the challenge of event reporting. Thromb Haemost. 2016; 116(4): 651-658. https://doi.org/10.1160/TH16-04-0305
20. DeCarolis S, di Pasquo RE, Del Sordo G, Buonomo A, Schiavino D, Lanzone A, et al. Fondaparinux in pregnancy: could it be a safe option? A review of the literature. Thromb Res. 2015; 135(6): 1049-1051. https://doi.org/10.1016/j.thromres.2015.04.001
21. Mauermann E et al. Heparin-induced thrombocytopenia in pregnancy: an interdisciplinary challenge-a case report and literature review. Int J Obstet Anesth. 2016; 26: 79-82. https://doi.org/10.1016/j.ijoa.2015.11.009
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