Thromboembolism In Pregnant Women Research Articles

AN UPDATE ON DIAGNOSIS AND MANAGEMENT OF THROMBOEMBOLISM IN PREGNANCY

Thromboembolism during pregnancy poses a significant challenge in maternal healthcare, substantially contributing to maternal morbidity and mortality worldwide. Understanding its diagnosis and management is crucial for improving maternal and fetal outcomes. Objective: To evaluate the diagnosis and management of thromboembolism in pregnant women. Methods: A retrospective cohort study was conducted at Lady Reading Hospital, Peshawar, from July 2022 to July 2024. The study included 175 pregnant females diagnosed with venous thromboembolism (VTE) during their pregnancy. Data were collected on patient demographics, trimester of diagnosis, type of thromboembolism (deep vein thrombosis [DVT] or pulmonary embolism [PE]), treatment modalities, and outcomes. Patients were treated with either low molecular weight heparin (LMWH) or unfractionated heparin (UFH). Descriptive statistics were used to analyze the data, with results presented as percentages and means with standard deviations. Results: The mean age of the participants was 32.01 ± 2.35 years. Thromboembolism was most commonly diagnosed in the third trimester (65%), followed by the second trimester (25%) and the first trimester (10%). DVT was observed in 74% of patients, while PE occurred in 26%. Among the 160 patients treated with LMWH, 3% (5 patients) experienced a recurrence of VTE. Of the 15 patients who received UFH, 5% (8 patients) had significant bleeding complications. Overall maternal outcomes included a 3% recurrence rate of VTE and a 5% rate of significant bleeding complications. No maternal mortality was reported. Conclusion: Early diagnosis and timely management of thromboembolism in pregnancy, mainly through the use of low molecular weight heparin and a multidisciplinary care approach, significantly improve maternal and fetal outcomes. LMWH was associated with fewer complications compared to UFH, highlighting its effectiveness and safety in treating pregnant women with VTE.

Risk factors related to venous thromboembolism in pregnant women: a meta-analysis.

The aim of this paper was to make a preliminary analysis of the risk factors related to venous thromboembolism (VTE) in pregnant women by Meta-analysis. Three databases including PubMed, Web of Science, and The National Library of Medicine (NLM) were systematically searched from their establishment to January 1, 2023, and the obtained data were statistically analyzed using RevMan5.3 software. A total of 10 studies were included, involving 22 risk factors, of which 16 were included for further analysis. Meta analysis showed that cesarean section (OR=2.05, 95%CI: 1.71, 2.47, P=0.007), gestational diabetes (OR=1.17, 95%CI: 1.09, 1.27, P<0.001), eclampsia or preeclampsia (OR=1.88, 95%CI: 1.42, 2.49, P< 0.001), obesity (OR=1.19, 95%CI: 1.04, 1.86, P=0.028), twin or multiple pregnancy (OR=2.34, 95%CI: 1.46, 3.76, P<0.001), chronic heart disease (OR=3.59, 95%CI: 3.28, 3.92, P<0.001), and blood transfusion history (OR=3.20, 95%CI: 2.78, 3.68, P<0.001) were risk factors for VTE in pregnant women. Existing evidence suggests that cesarean section, gestational diabetes, eclampsia or preeclampsia, obesity (body mass index ≥30 kg/m2), twin or multiple pregnancy, chronic heart disease, and blood transfusion history may be risk factors for VTE in pregnant women. In clinical practice, the evaluation and management of VTE should be strengthened, and a model for clinical prediction of VTE can be established to provide a reference for the prevention of VTE.

Debating points of anticoagulation in the prevention of venous thromboembolism in pregnant women with cardiovascular and systemic diseases. Expert council resolution

On December 18, 2022, an interdisciplinary Expert Council was held in St. Pe­ter­sburg, dedicated to the debatable issues of anticoagulation in the prevention of venous thromboembolism in pregnant women with cardiovascular and systemic diseases, at which a number of proposals and guidelines were adopted, and the results of the Highlow study were considered. Leading experts from the Russian Society of Cardiology, the Russian Society of Obstetricians and Gynecologists, the National Association of Specialists in Thrombosis, Clinical Hemostaseology and Hemorheology took part in the Expert Council.

Prevention of venous thromboembolism in pregnant women with congenital antithrombin deficiency: a retrospective study of a candidate protocol.

The best thromboprophylaxis for pregnant women with congenital antithrombin deficiency (CAD) is controversial. To clarify the effectiveness of a protocol for venous thromboembolism (VTE) prevention in pregnant women with CAD. Women at high risk of VTE were administered antithrombin concentrate and heparin after conception, whereas those at low risk of VTE were administered heparin alone until delivery. All women received antithrombin concentrate at delivery except for one who was diagnosed with CAD. Ten women had CAD, including one in the high-risk group and nine in the low-risk group. No women had VTE at delivery as per the protocol for VTE prevention. Almost all women had increased antithrombin activity before delivery followed by maintenance at ≥ 70% due to antithrombin concentrate administration. VTE prophylaxis during and after delivery was successful in all women with CAD. However, one woman in the low-risk group did not receive heparin and developed VTE induced by severe hyperemesis at 9 gestational weeks, before the diagnosis of CAD. Women in the high-risk group received antithrombin concentrate after delivery but had increased D-dimer levels at postpartum. Our protocol to prevent VTE in pregnant women with CAD is safe and effective.

Surgical treatment of thromboembolia in the heart right atrium in pregnant women

Two clinical cases of surgical treatment of cardiac right-chamber thromboembolism in pregnant women are described. Thromboembolism was diagnosed during a routine examination. In the first clinical case, considering the late pregnancy, a thromboembolectomy was performed under artificial circulation after surgical delivery.In the second case, thrombus removal from the right atrium was performed on a working heart, without interruption of pregnancy. The surgical and postsurgical period proceeded without any specific features and the patients were discharged from the hospital without any complications. These clinical cases show that it is possible to remove thrombus from the right heart chambers without the use of extracorporeal circulation, which is also safe for the mother and the fetus.

Working to reduce the problem of thromboembolism in pregnant women.

Ediscyll Lorusso, Senior Thrombosis Specialist Nurse Practitioner, St George's University Hospitals NHS Foundation Trust, was awarded third place in the Nurse of the Year category in the BJN Awards 2021.

Anticoagulant treatment of venous thromboembolism in pregnant women

Venous thromboembolism (VTE), in particular pulmonary embolism (PE), remains the leading cause of death among pregnant women. Low-molecular-weight heparin (LMWH), with preference for therapeutic doses given twice daily according to European guidelines, is the drug of choice for the treatment of VTE in pregnancy and the puerperium. The recommended therapeutic dose is calculated on early pregnancy body weight. Evidence to support anti-Xa monitoring in pregnancy is weak. Unfractionated heparin (UFH) with multiple activated partial thromboplastin time measurements is still used in the acute treatment of high-risk PE. American experts have suggested considering initial outpatient therapy over hospital admission also in pregnant women with low-risk acute VTE, but European experts suggest adopting such a strategy selectively, for example in isolated distal leg thrombosis. Scheduled delivery with prior discontinuation of anticoagulant therapy in pregnant women who received a therapeutic dose of LMWH is suggested with the restart of therapy 4–6 h after a vaginal birth and 6–12 h after a cesarean delivery. It is recommended that UFH, LMWH, warfarin, acenocoumarol, or fondaparinux, but not direct-acting oral anticoagulants, should be used in breastfeeding women. This review summarizes the key messages from current guidelines mainly based on low-quality evidence and expert consensus.

Clinical cases of myocardial infarction in pregnant women: the role of hereditary thrombophilia

Acute myocardial infarction during pregnancy is a threatening complication with high maternal and perinatal mortality. According to the literature, hereditary thrombophilia is commonly associated with obstetric disorders and susceptibility to venous thrombosis, whereas arterial part of the vasculature, including coronary, is rarely involved. The article describes two clinical cases of pregnant women with acute myocardial infarction and post-infarction cardiosclerosis, in whom hereditary thrombophilia, associated with the gene PAI-1-675 polymorphism, was diagnosed. Mothers of both patients had suffered myocardial infarction at a young age, while past history of only one pregnant woman was remarkable for multiple perinatal losses. Myocardial infarction may manifest with intense headache mirroring systemic angiospasm.Based on the clinical observations of acute myocardial infarction in pregnancy, one could conclude that measurements of troponin levels that might be false negative should be done repeatedly, while the signs of transmural myocardial injury at ECG can evolve into those of an intramural myocardial infarction. Miscarriage and fetoplacental insufficiency have been found in the patients with combination of hereditary thrombophilia and myocardial injury. Coronary artery damage in pregnant women can be the result of hereditary thrombophilia, most often associated with the PAI-1-675 gene polymorphism, as well as its combination with the heterozygous state of other genes.The absence of past perinatal losses and venous thromboembolism in pregnant women with myocardial infarction does not exclude hereditary thrombophilia, and additional work-up of the patient and the proband family is mandatory to exclude the underlying pathology. The course of myocardial infarction may not require an intracoronary intervention, and treatment may consist of non-fractionated or low molecular weight heparin and calcium antagonists.

The Risk of Venous Thromboembolism in Pregnant Women with Essential Thrombocythemia: A Systematic Review and Meta-Analysis

Introduction: There is an increased risk of venous thromboembolism (VTE) in patients with essential thrombocythemia (ET), however, what the absolute VTE risk is during pregnancy is largely unknown and is based on small cohort or registry studies. Recommendation for the use of low-molecular-weight heparin (LMWH) prophylaxis in the antepartum and/or postpartum setting is based on the absolute VTE and bleeding risk in other patient populations, for example, in women with inherited thrombophilia. A better estimate of absolute VTE risk will provide guidance for the use of LMWH in pregnant women with ET, as well as other treatments such as interferon.Objective: The aim of our meta-analysis is to quantify the absolute risk of VTE with or without LMWH prophylaxis in women with ET during pregnancy and in the postpartum setting.Methods: A systematic literature search was conducted on MEDLINE, EMBASE and EBM reviews. The primary outcome was VTE and the secondary outcomes were bleeding events and arterial thromboembolism (ATE). Studies were excluded if less than 5 pregnancies were reported, or if there was any duplication in publication, then only the most recent study was included. Using a standardized form, data was extracted independently by two investigators with disagreements resolved by consensus (L.S. and M.A.R.). Data on the use of LMWH, aspirin (ASA) and interferon was collected. Primary and secondary outcomes were reported per pregnancy in the antepartum and postpartum setting using pooled proportions, with 95% confidence intervals reported. Pregnancies ending in first trimester loss were excluded from the postpartum VTE analysis. Peripartum bleeding (delivery to 24 hours) was excluded. Placental abruptions were included as bleeding events.Results: There were 21 studies included that reported outcomes of interest in 504 patients and 756 pregnancies (1991-2016). Ten authors provided additional data. Among 756 pregnancies, there were 8 VTE events in the antepartum setting (1.06%, 95% CI, 0.54-2.07). Among 607 pregnancies (excluding first trimester losses), there were 8 VTE events in the postpartum setting (1.32%, 95% CI, 0.67-2.58). Of the 18 studies that reported VTE with respect to antepartum LMWH prophylaxis use, there were 0 antepartum VTE events among 82 pregnancies with LMWH use (0%, 95% CI, 0.0-4.48), and 8 antepartum VTE events among 407 pregnancies without LMWH use (1.97%, 95% CI, 1.00-3.83). Of the 14 studies that reported VTE with respect to postpartum LMWH prophylaxis use in pregnancies that excluded first trimester losses, there were 0 postpartum VTE events among 96 pregnancies with LMWH use (0%, 95% CI, 0.0-3.85), and 6 postpartum VTE events among 229 pregnancies without LMWH use (2.62%, 95% CI, 1.21-5.60) (Table 1).There were 12 antepartum bleeds reported in 756 pregnancies (1.59%, 95% CI, 0.91-2.75), 9 of which were placental abruptions (1.19%, 95% CI, 0.63-2.25). There were 11 postpartum bleeds reported in 756 pregnancies (1.46%, 95% CI 0.81-2.59). Bleeding according to LMWH prophylaxis use in the antepartum and postpartum setting is presented in Table 1. Among 756 pregnancies, there were 4 possible ATE events described in the antepartum setting: transient visual loss after ASA was held for 1 week, an ocular TIA at 6 weeks gestation while on ASA, and 2 patients who described both visual disturbance and dizziness with unknown ASA use. No patient with possible ATE received LMWH prophylaxis.Conclusion: Women with ET who are pregnant have an increased risk of VTE in both the antepartum and postpartum setting compared to the general pregnant population. The absolute risk of VTE in the antepartum and postpartum setting is not above a threshold where LMWH is clearly indicated or below a threshold where LMWH should be withheld. The role of thromboprophylaxis in this setting requires a shared decision-making process, taking into account patient values and preferences and the risks and benefits of LMWH. [Display omitted] DisclosuresCarrier:BMS: Research Funding; Leo Pharma: Research Funding. Robinson:Novartis: Honoraria; Pharmacosmos: Honoraria; Amgen: Honoraria. Rodger:Boehringer Ingelheim: Research Funding; Canadian Agency for Drugs and Technologies in Health: Consultancy.

Intrapartum temporary inferior vena cava filters are rarely indicated in pregnant women with deep venous thromboses.

We previously demonstrated the usefulness of temporary inferior vena cava filters (t-IVCFs) to prevent pulmonary thromboembolism in pregnant women with deep venous thrombosis (DVT). However, there is currently no consensus on the indications for intrapartum t-IVCF in pregnant women with DVT. In this study, we re-evaluated the safety and usefulness of t-IVCF inserted in this condition. A retrospective evaluation in a single center was performed of 45 Japanese patients (54 pregnancies) with DVT between 1989 and 2014. Intrapartum t-IVCF insertion was indicated in patients who had or might have had extensive DVT located in iliofemoral veins and who had floating thrombi in the veins of their lower limbs. Eighteen patients (40%) had thrombophilias. Onset of DVT and delivery occurred at 17 ± 9 weeks and 37 ± 2 weeks of gestation, respectively. Twenty pregnant women underwent placement of an intrapartum t-IVCF. All t-IVCFs were successfully placed in the suprarenal inferior vena cava before delivery. Filter-related complications occurred in two cases (10%). One was an allergic reaction to the lidocaine used at the insertion, and another was dislocation of the t-IVCF to the right atrium. The t-IVCFs were placed for more acute DVT compared with the 34 pregnancies without t-IVCF; the onset of DVT with t-IVCF was significantly later (22 vs 12 weeks; P = .002), and the duration of unfractionated heparin therapy was significantly shorter (16 vs 28 weeks; P < .001). There was no case of clinical pulmonary embolism in the perinatal period. Thrombus was detected macroscopically at the removed t-IVCF in 15 cases; however, almost all were minute pieces. In only one case with protein S deficiency and placental abruption was a large thrombus captured in the t-IVCF, which was considered to have prevented a clinically relevant pulmonary embolus. Placement of a t-IVCF appears to be safe for pregnant women. However, intrapartum t-IVCF insertion is considered to be unnecessary for pregnant women with DVT who have received anticoagulation therapy at early onset of gestation and long term before delivery. Patients with thrombophilia and at high risk of hemorrhage may represent a subgroup of women who would benefit from t-IVCF placement, but larger prospective multicenter evaluations are required to establish that fact.

Value and Implications of the Anti-Xa Activity Monitoring for Prophylactic Dosing Adjustment of LMWH in Pregnancy: A Retrospective Study

▪Introduction: Low molecular weight heparins (LMWH) have stable pharmacokinetics. However, physiologic changes during pregnancy can alter pharmacokinetics of LMWH and make the biodisponibility of the drug less predictable. When starting prophylactic treatment with LMWH in pregnant woman, most physicians calculate the initial LMWH dose based on the body weight and adapt the dose according to the weight gain. An alternative method is to monitor the anti-Xa activity and adjust the LMWH dose accordingly. LMWH are for the moment the only anticoagulant available for prophylaxis of venous thrombo-embolism in pregnant women and prevention of severe pregnancy complications. Therefore, we conducted a study addressing the rationality of performing an anti-Xa activity monitoring regularly during pregnancy.Methods: We retrospectively analyzed data from pregnant women undergoing prophylaxis with LMWH followed at the Hemostasis and Thrombosis Unit of the Saint-Luc University Hospital Unit. All the patients that had anti-Xa activity done at least three times during pregnancy were included in the study. The measurements of anti-Xa were done regularly every 6 weeks and the dose of LMWH was increased in case of anti-Xa activity lower than 0.3 U/ml. Initial LMWH dose was calculated based on the patient body weight and the first measurement of anti-Xa done 10 days afterwards.Results: Out of 173 women evaluated in the study, 79% needed LMWH dose adjustment. 97 patients (56%) had one dose adjustment, 35 patients (20%) two and 5 patients (3%) three. The first augmentation of LMWH dose was needed before the patient gained body weight in 36,5% of cases. The average increase of the LMWH dose was 49%, 100% and 116% for the one, two and three dose adjustments, respectively. Under-dosing of LMWH, defined as anti-Xa activity <0,2 U/mL, was present in 12% of patients on the first monitoring versus 3,5% on the last monitoring visit. No severe side effects occurred during the treatment. Five patients (3%) had unfavorable outcome of the pregnancy.Conclusions: This study demonstrates that regular monitoring of anti-Xa activity can help in maintaining the prophylactic levels of LMWH throughout the pregnancy. We also showed that the reduction of the anti-Xa activity is not always directly correlated with the weight gain in pregnant women. Therefore we recommend that LMWH dose adjustment should not be made based solely on the weight gain of the patient during pregnancy. DisclosuresNo relevant conflicts of interest to declare.

Risk of First Venous Thromboembolism in Pregnant Women in Hospital

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Venous thromboembolism in pregnant women with sickle cell disease: A retrospective database analysis

IntroductionThe risk of venous thromboembolism (VTE) is higher during pregnancy, with an incidence between 0.05 and 0.2%, and among persons with sickle cell disease (SCD), yet the rates and risk factors, such as pneumonia, vasooclusive crisis (VOC), and acute chest syndrome (ACS), associated with pregnancy-related VTE are not firmly established in SCD. MethodsInpatient hospital discharge data from 2007-2011 were obtained from the Pennsylvania Health Care Cost Containment Council to estimate the rate of VTE among African American delivery hospitalizations with SCD and to compare pregnancy complications and medical comorbidities among pregnant women with SCD. ResultsAmong 212 hospitalized deliveries in African-American women with SCD, 6 (2.8%, 95% CI 1.0%-5.9%) had VTE compared to 0.05 to 2.0% in the general population. Risk factors for VTE included pneumonia and diabetes mellitus. Overall, the prevalence of VTE, among hospitalized deliveries in SCD women with pneumonia, VOC, and/or ACS, 6.6%, was significantly greater than among those without these conditions, 2.2%, p<0.001. ConclusionPregnancy-related VTE in women with SCD appears to be 1.5 to 5 times greater than pregnancy-related VTE in the general population. The higher prevalence of VTE among pregnant women with pneumonia, VOC, and/or ACS, and their potential clinical overlap, suggests that VTE may be missed in such women. We conclude that VTE in pregnant women with SCD may be more common than previously reported, and such women might be candidates for thromboprophylaxis.

Journal Watch November 2013 – February 2014

Risk of first venous thromboembolism in pregnant women in hospital: population based cohort study from England.

Venous Thromboembolism In Pregnant Women With Sickle Cell Disease

BackgroundThe risk of venous thromboembolism (VTE) is increased in pregnancy and sickle cell disease (SCD), yet the rates of pregnancy-related VTE are not firmly established in SCD, nor are other SCD-related complications, including pneumonia, vasooclusive crisis (VOC), and acute chest syndrome (ACS), which may be clinically indistinguishable from VTE. Moreover, the American College of Chest Physicians has made no recommendations regarding thromboprophylaxis in pregnant women with SCD. MethodsInpatient hospital discharge data for PE for the most recent 5-year period available, 2007-2011, were obtained from the Pennsylvania Health Care Cost Containment Council (PHC4). We compared VTE, pregnancy complications, medical co-morbidities, and mortality among pregnant women with and without SCD. Among pregnant SCD women with and without VTE, we also compared rates of pneumonia, vasooclusive crisis (VOC), and acute chest syndrome (ACS). All patient identifiers were removed. Diagnostic categories and co-morbidities were obtained using ICD-9 codes. Data from categorical variables were analyzed by chi-square or Fisher's exact test; and from continuous variables by two-sample Student t-test. ResultsThe prevalence of VTE was 2.8% among pregnant women with SCD. Among pregnant women with SCD and VTE, the rate of pneumonia, 28.6% vs. 4.4%, p=0.043, was significantly higher than in those without VTE. While somewhat higher, the rates of VOC, 57.1% vs. 24.7%, p=0.073, and ACS, 14.3% vs. 2.4%, p=0.177, were not significantly different between pregnant SCD VTE and non-VTE groups. Comparing VTE and non-VTE pregnant SCD women, the rate of pregnancy complications did not differ, p=0.999; nor did the rates of medical co-morbidity, other than diabetes, 28.6% vs. 3.6%, p=0.031. Among the subset of pregnant SCD with pneumonia, the prevalence of VOC, 80.0% vs. 36.1%, p=0.001; ACS, 35.0% vs. 2.9%, p<0.001; and length of stay, 12.5 vs. 4.6 days, p=0.030, were significantly greater than in those without pneumonia. Among the subset of SCD pregnancies with VOC, the prevalence of preeclampsia, 28.4% vs. 13.5%, p=0.003; pneumonia, 15.7% vs. 2.6%, p=0.001; ACS, 12.8% vs. 0.6%, p<0.001; and length of stay, 7.7 vs. 3.6 days, p<0.001, were significantly more common than in those without VOC. Among the subset of SCD pregnancies with ACS, the rates of intrauterine fetal death, 14.3% vs. 1.6%, p=0.036; postpartum infection, 28.6% vs. 6.6%, p=0.016; pneumonia, 50.0% vs. 5.3%, p<0.001; and VOC, 92.9% vs. 36.5%, p<0.001, were significantly higher than in those without ACS. Overall, the rate of VTE, among SCD women with pneumonia, VOC, and/or ACS, 6.6%, was significantly higher than among those without these conditions, 2.2%, p<0.001. DiscussionThe prevalence of pregnancy-related VTE in women with SCD, while low, 2.8%, appears to be at least 10-fold greater than the general 0.2% incidence of pregnancy-related VTE in the unaffected population. Further, the higher rates of VTE we observed among pregnant women with SCD-related complications, including pneumonia, VOC, or ACS, and the well-recognized potential clinical overlap with VTE, suggest that VTE may be missed in such women, and that VTE rates in pregnant women with SCD may be higher than herein reported or previously recognized. The presence of pneumonia, VOC, or ACS appears to be associated with VTE and may be a potential marker(s) of its occurrence. Prospective studies, however, are needed to determine the incidence of VTE in pregnant women with SCD with and without complicating pneumonia, VOC, and/or ACS. We conclude that pregnancy-related VTE may be more common than previously recognized in pregnant women with SCD and, if confirmed, such women might be candidates for thromboprophylaxis. Disclosures:No relevant conflicts of interest to declare.

Risk of first venous thromboembolism in pregnant women in hospital: population based cohort study from England

Objective To examine the potential for preventing venous thromboembolism during and after antepartum hospital admissions in pregnant women.Design Cohort study using linked primary (Clinical Practice Research Datalink) and secondary (Hospital...

PCV30 - The Humanistic and Economic Burden of Venous Thromboembolism in Pregnant Women: A Systematic Review

PCV30 - The Humanistic and Economic Burden of Venous Thromboembolism in Pregnant Women: A Systematic Review

Venous thromboembolism in pregnant woman — a challenge for the clinician

Abstract Deep vein thrombosis and pulmonary embolism are two clinical entities of a single disease called venous thromboembolism. Venous thromboembolism is an important cause of maternal morbidity and mortality. Diagnosis and treatment of venous thromboembolism in pregnant women are much more difficult than in non-pregnant women. Pregnant patients were excluded from all major clinical trials investigating therapeutic combinations for acute thromboembolism. Although, for many years, the standard anticoagulant during pregnancy and postpartum was unfractionated heparin, current guidelines recommend low molecular weight heparin. The advantages of low molecular weight heparin are lower risk of bleeding, predictable pharmacokinetics, lower risk of fracture because of thrombocytopenia and heparin-induced osteoporosis.

Incidence of pulmonary and venous thromboembolism in pregnancies after in vitro fertilisation: cross sectional study

Objective To estimate the risk of pulmonary embolism and venous thromboembolism in pregnant women after in vitro fertilisation.Design Cross sectional study.Setting Sweden.Participants 23 498 women who had given birth after...

Antithrombotic Therapy for Pregnant Women

Coagulability increases during pregnancy, and thromboembolism can easily occur. Venous thromboembolism is a cause of death in pregnant women, but arterial thrombosis such as ischemic stroke in pregnancy is also not uncommon. In pharmacotherapy for thromboembolism in pregnant women, fetal toxicity and teratogenicity must be carefully considered. As anticoagulants in pregnant women, unfractionated heparin and low-molecular-weight heparin are recommended, but warfarin is not recommended since it has a low molecular weight and crosses the placenta. Various types of new oral anticoagulant drugs have been available in Japan since 2011. However, the Japanese package inserts for these anticoagulants advise quite cautious administration in pregnant women. The guidelines on pregnant women include less information about antiplatelet drugs than anticoagulant drugs. Aspirin may cause teratogenicity and fetal toxicity, and perinatal mortality is increased. However, when low doses of aspirin are administered as antiplatelet therapy, the US Food and Drug Administration has assigned pregnancy category C, and treatment is relatively safe. Neurosurgeons and neurologists commonly encounter pregnant women with thromboembolism, such as ischemic stroke. Up-to-date information and correct selection of drugs are necessary in consultation with specialists in perinatal care.