How to Cite
1.
Camacho Solís AE, Méndez Zamora AM, Martín Zamora AC. Thromboembolic events and pregnancy: an update on anticoagulation in pregnant women. Rev.méd.sinerg. [Internet]. 2019May1 [cited 2024Jul.3];4(5):77 - 88. Available from: https://revistamedicasinergia.com/index.php/rms/article/view/210
Abstract
Pregnancy is associated with multiple physiological and anatomical changes that make it a prothrombotic state. The combination of such factors results in a 5-fold increase in the risk for venous thromboembolism in these patients. There are multiple conditions, independent or related to pregnancy, in which there is an indication for pharmacological thromboprophylaxis or anticoagulation during pregnancy and the postpartum period. In order to start anticoagulant therapy in a pregnant woman the risks and benefits for both the woman and the fetus should be taken into consideration according to the time of gestation. Even though low molecular weight heparins are the treatment of choice for most indications, there are cases in which warfarin or direct oral anticoagulants are of use and may be the first line of treatment.
Keywords
thrombosis. venous thromboembolism. pregnancy. anticoagulants. heparin. warfarin.
References
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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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