Vein Thrombosis In Pregnancy Research Articles

Superficial vein thrombosis in pregnancy: what we did not know could hurt our patients

Superficial vein thrombosis in pregnancy: what we did not know could hurt our patients

Functionally integrating nanoparticles alleviate deep vein thrombosis in pregnancy and rescue intrauterine growth restriction

There is still unmet demand for effective, safe, and patient-friendly anti-thrombotics to treat deep vein thrombosis (DVT) during pregnancy. Here we first engineer a bioactive amphiphile (TLH) by simultaneously conjugating Tempol and linoleic acid onto low molecular weight heparin (LMWH), which can assemble into multifunctional nanoparticles (TLH NP). In pregnant rats with DVT, TLH NP can target and dissolve thrombi, recanalize vessel occlusion, and eradicate the recurrence of thromboembolism, thereby reversing DVT-mediated intrauterine growth restriction and delayed development of fetuses. Mechanistically, therapeutic effects of TLH NP are realized by inhibiting platelet aggregation, facilitating thrombolysis, reducing local inflammation, attenuating oxidative stress, promoting endothelial repair, and increasing bioavailability. By decorating with a fibrin-binding peptide, targeting efficiency and therapeutic benefits of TLH NP are considerably improved. Importantly, LMWH nanotherapies show no toxicities to the mother and fetus at the dose 10-time higher than the examined therapeutic dosage.

Clinical Relevance of Ovarian Vein Thrombosis in Pregnancy and Postpartum [A197

INTRODUCTION: Ovarian vein thrombosis (OVT) is a rare complication of pregnancy and can result in sepsis, extensive thrombosis and secondary venous thromboembolism (VTE). Treatments range from observation to anticoagulation and antibiotics. This study aims to identify the incidence of secondary VTE and factors that correlate with subsequent VTE. METHODS: After institutional review board approval, a cross-sectional study of patients diagnosed with OVT in the peripartum period from 2012 to 2020 at our institution was performed. The incidence of secondary VTE and their clinical management was reviewed. Descriptive statistics were performed to identify risk factors for secondary VTE. Numeric variables were compared using Mann-Whitney U test, and categorical variables were compared using chi-square or Fischer’s exact test. RESULTS: A total of 37 postpartum patients with OVT were included. The incidence of secondary VTE was 16.2% (6 patients). Patient characteristics including age, race, BMI, tobacco use, mode of delivery, cesarean hysterectomy, and chorioamnionitis were similar between patients with OVT alone and OVT with secondary VTE (P=.918, .911, 1, .115, 1, .62, .535, respectively). Radiographic measurement of OVT extension into the IVC or renal veins as both continuous or nominal variables did not confer increased risk of secondary VTE. CONCLUSION: Secondary VTE following OVT occurred in 16% of women in this select population. No clinical or demographic factors were found to be significant for a higher risk of developing VTE. Although OVT is rare, it is associated with significant maternal morbidity and mortality. Future studies are needed to identify high-risk patients for secondary outcomes of OVT and improve therapeutic guidelines.

Bilateral deep vein thrombosis in pregnancy as first manifestation of an anomalous inferior vena cava.

Bilateral deep vein thrombosis in pregnancy as first manifestation of an anomalous inferior vena cava.

Risk Factors for Deep Vein Thrombosis in Pregnancy and Puerperium at a Tertiary Care Hospital in Muzaffarabad, AJK

Aim: Risk factors of deep vein thrombosis in pregnancy and puerperium in our setting. Study Design: Descriptive Cross-sectional study Place and duration of study: Departments of Obs & Gynae and General Medicine, CMH Muzaffarabad, AJK from 20th December, 2019 to 20th June, 2020. Methodology: A total of 385 females were included. Demographic data including age, parity, gravidity, BMI, obesity and timing of DVT occurrence was noted. The associated risk factors including mode of delivery in postpartum women, smoking status, past history of DVT, gestational diabetes and Diabetes Mellitus were noted. Results: Mean age of the participants was 26.1±5.3 years. Frequency of women developing deep vein thrombosis during pregnancy was 84.9% and 15.1% women developed DVT during puerperium. Past history of DVT was present in 26.5%. 31.7% of women were known diabetics and 29.1% developed gestational diabetes during current pregnancy. Frequency of smoking was 4.2%. 8% women presented with DVT in first trimester, 139(36.1%) in second trimester and 154 (40%) in third trimester. Conclusion: DVT is more common in the third trimester of pregnancy than in puerperium. Obesity, Diabetes Mellitus and past history of DVT were significant risk factors identified in the study. Keywords: Pregnancy, Postpartum Period, Deep Vein Thrombosis

Deep vein thrombosis in pregnancy

Venous thrombotic events (VTE) prevalence is estimated to be 1-2 for every 10,000 pregnancies, making it one of main causes of maternal mortality in developed countries. VTE’s leading risk factors are history of the condition and hereditary thrombophilia. D-dimer tests conducted during pregnancies have in many cases led to false positive results while a few false negatives have also been found. For pregnant women, it is important for evaluation to begin with compression ultrasound before magnetic resonance imaging, which seeks a negative test and focuses on the pelvis. On the other hand, a chest x-ray should be done for pulmonary embolism, which helps in deciding between a CT pulmonary angiogram and perfusion study for normal and abnormal x-ray, respectively. Generally, treatment is composed of heparin of low molecular weight for at least six weeks after childbirth. Thrombolysis can be significant for life-threatening and serious thrombolysis. For populations at high risk, VTE prophylaxis still faces a lot of uncertainty. In fact, there is still little evidence to support the essence of mechanical prophylaxis for all women who have delivered through cesarean.

Telangiectatic osteosarcoma initially presenting as right popliteal vein thrombosis in pregnancy: A case report

Background: Telangiectatic Osteosarcoma (TO) is a rare variant of osteosarcoma. The rarity of TO and its similar initial presentation with Deep Vein Thrombosis (DVT) often leads to missed diagnosis or misdiagnosis during the primary evaluation.Case presentation: A 30-year-old Para 1+0 Gravida 2 presented with right lower limb swelling with knee effusion, right lower leg thrombosis, and TO at 30 weeks gestation to the Kenyatta National Hospital (KNH). Serial limb measurements, analgesics for lower limb pain, fetal heart rate, and movement monitoring were done. Disarticulation at the hip joint was scheduled, but the case declined further care, opting for expectant management. She had an intrauterine fetal demise and delivered a macerated stillbirth at 31 weeks of gestation. She was admitted for one day in the labor ward, discharged, and was lost to follow-up.Conclusion: Telangiectatic osteosarcoma can present as right popliteal vein thrombosis.

Anticoagulation Management of Deep Vein Thrombosis in Pregnancy: Anti-Xa Levels Matter

Anticoagulation Management of Deep Vein Thrombosis in Pregnancy: Anti-Xa Levels Matter

Deep Vein Thrombosis in Pregnancy: A Review Article

Deep Vein Thrombosis in Pregnancy: A Review Article

Chronic Extra-Hepatic Portal Vein Obstruction in a Pregnant Patient Requiring TIPS: A Case Report

Abstract Extra-Hepatic Portal Vein Obstruction (EHPVO) is due to non-cirrhotic or malignant causes and may present with signs and symptoms of chronic portal hypertension. Here we discuss a patient on her fifth pregnancy who was discovered to have EHPVO with cavernous transformation and perisplenic, gastohepatic and retroperitoneal varices after presenting with abdominal pain, splenomegaly, and unremarkable labs. An emergent Transjugular Intrahepatic Portosystemic Shunt (TIPS), although rarely feasible in the presence of cavernous formation, with percutaneous thrombectomy of the superior mesenteric vein, splenic vein, and hepatic portal veins was performed. Unfortunately, post-procedural complications resulted in hypovolemic shock and spontaneous abortion. Genetic testing and bone marrow biopsy confirmed the diagnosis of essential thrombocythemia in the setting of a Janus Kinase2 (JAK2) V617F mutation. Portal vein thrombosis in pregnancy is rare, however, hemodynamic changes of pregnancy may increase the risk of complications due to portal hypertension. Additionally, the diagnosis of primary myeloproliferative disorders is a known risk factor for EHPVO. While prophylaxis and close monitoring is suggested in patients with a history of EHPVO before conception, there is no clear protocol in treating patients who are diagnosed for the first time with chronic EHPVO during pregnancy. Keywords JAK2V617F Mutation; Portal vein thrombosis; Pregnancy; TIPS Abbreviations EHPVO: Extra-hepatic portal vein obstruction; ET: Essential thrombocythemia; JAK2: Janus Kinase2; MPD: Myeloproliferative disorders; PV: Polycythemia Vera; PVT: Portal vein thrombosis; TIPS: Transjugular intrahepatic portosystemic shunt

A case of aplastic anemia with chronic kidney disease complicated by deep vein thrombosis in pregnancy

A case of aplastic anemia with chronic kidney disease complicated by deep vein thrombosis in pregnancy

Mesenteric cysts and mesenteric venous thrombosis leading to intestinal necrosis in pregnancy managed with laparotomy: a case report and review of the literature

BackgroundMesenteric cyst is a rare clinical entity especially in pregnancy; therefore, few cases have been reported in the literature. The standard method of their treatment is surgical excision either with laparotomy or laparoscopy. In addition, mesenteric vein thrombosis is a rare and life-threatening condition in pregnancy and needs immediate treatment because it can lead to intestinal necrotic ischemia. This is the first report of the coexistence of mesenteric cysts and mesenteric vein thrombosis during gestation.Case presentationA 27-year-old Greek woman, gravida 2 para 1, presented at 10 weeks’ gestation to the Emergency Unit of our hospital complaining of diffuse abdominal pain which deteriorated the last 3 days, which was localized in her right iliac fossa, along with vomiting. She had undergone open laparotomy and right salpingo-oophorectomy at the age of 23 due to an ovarian cyst. Besides this, her personal and family medical history was unremarkable. She had never received oral contraceptives or any hormone therapy. On arrival, a clinical examination revealed tenderness on palpation of her right iliac fossa, without rebound tenderness or muscle guarding. Within 10 hours of hospitalization, her symptoms deteriorated further with rebound tenderness during the examination, tachycardia, and a drop of 12 units in her hematocrit value. An emergency laparotomy was performed. Two mesenteric cysts and a 60 cm necrotic part of her intestine were revealed intraoperatively. In the postoperative period, she complained of acute abdominal pain, tachycardia, and dyspnea. Computed tomography imaging revealed mesenteric vein thrombosis and pulmonary thromboembolism. She was treated with low molecular weight heparin and she was discharged on the 11th postoperative day.ConclusionsTo the best of our knowledge, this is the first report in the literature of a simultaneous mesenteric cyst and mesenteric vein thrombosis in pregnancy. It is known that pregnancy is a state of hypercoagulation and clinicians should bear in mind this rare clinical condition in their diagnostic algorithm for acute abdominal pain.

Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy.

We aimed to describe ultrasonography (US)-guided percutaneous aspiration thrombectomy in pregnant women with iliofemoral deep vein thrombosis. This study included nine pregnant women with acute and subacute iliofemoral deep vein thrombosis, who were severe symptomatic cases with massive swelling and pain of the leg. Patients were excluded from the study if they had only femoropopliteal deep vein thrombosis or mild symptoms of deep vein thrombosis. US-guided percutaneous aspiration thrombectomy was applied to achieve thrombus removal and uninterrupted venous flow. The treatment was considered successful if there was adequate venous patency and symptomatic relief. Complete or significant thrombus removal and uninterrupted venous flow from the puncture site up to the iliac veins were achieved in all patients at first intervention. Complete relief of leg pain was achieved immediately in seven patients (77.8%). Two patients (22.2%) had a recurrence of thrombosis in the first week postintervention. One of them underwent a second intervention, where percutaneous aspiration thrombectomy was performed again with successful removal of thrombus and establishment of in line flow. Two patients were lost to follow-up after birth. None of the remaining seven patients had rethrombosis throughout the postpartum period. Symptomatic relief was detected clinically in these patients. Endovascular treatment with US-guided percutaneous aspiration thrombectomy can be considered as a safe and effective way to remove thrombus from the deep veins in pregnant women with acute and subacute iliofemoral deep vein thrombosis.

Isolated iliac vein thrombosis in pregnancy

Isolated iliac vein thrombosis in pregnancy

Educational Exhibit Abstract No. 362 - Management of lower extremity deep vein thrombosis in pregnancy

Learning Objectives Review the existing published guidelines regarding management of DVT in pregnancy. Discuss all treatment options including techniques, risks and benefits, and outcomes: conservative management, including anticoagulation and compression stockings; catheter-directed treatments, including lytic infusion catheters and pharmacomechanical thrombolysis (Trellis, Angiojet). Surgical thrombectomy. Understand the special considerations regarding treatment for DVT in pregnant patients: radiation effects on the fetus Medication effects on the fetus (tPA, heparin, warfarin, sedation medications); anticoagulation recommendations; mechanical compression of the gravid uterus on the iliac vein, including stents. Background Pregnancy poses a multi-factorial, two to four fold increase in risk of deep venous thrombosis (DVT). Prominent amongst these include hypercoagulability, venous stasis, immobility and mechanical compression from the gravid uterus. Effective guidelines regarding the optimal approach and treatment of DVT in pregnant patients are outdated or lacking, to the detriment of these patients. Clinical Findings/Procedure Details None Conclusion and/or Teaching Points Management of lower extremity DVT in pregnancy is an evolving topic, especially regarding newer interventional treatments, with limited data and guidelines. In order to optimally counsel and manage these patients, an understanding of all treatment options and the special considerations regarding treatment for DVT in pregnancy is required.

Liver diseases in pregnancy: Diseases not unique to pregnancy

Pregnancy is a special clinical state with several normal physiological changes that influence body organs including the liver. Liver disease can cause significant morbidity and mortality in both pregnant women and their infants. Few challenges arise in reaching an accurate diagnosis in light of such physiological changes. Laboratory test results should be carefully interpreted and the knowledge of what normal changes to expect is prudent to avoid clinical misjudgment. Other challenges entail the methods of treatment and their safety for both the mother and the baby. This review summarizes liver diseases that are not unique to pregnancy. We focus on viral hepatitis and its mode of transmission, diagnosis, effect on the pregnancy, the mother, the infant, treatment, and breast-feeding. Autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, Wilson's disease, Budd Chiari and portal vein thrombosis in pregnancy are also discussed. Pregnancy is rare in patients with cirrhosis because of the metabolic and hormonal changes associated with cirrhosis. Variceal bleeding can happen in up to 38% of cirrhotic pregnant women. Management of portal hypertension during pregnancy is discussed. Pregnancy increases the pathogenicity leading to an increase in the rate of gallstones. We discuss some of the interventions for gallstones in pregnancy if symptoms arise. Finally, we provide an overview of some of the options in managing hepatic adenomas and hepatocellular carcinoma during pregnancy.

Liver diseases in pregnancy: Diseases unique to pregnancy

Pregnancy is a special clinical state with several normal physiological changes that influence body organs including the liver. Liver disease can cause significant morbidity and mortality in both pregnant women and their infants. This review summarizes liver diseases that are unique to pregnancy. We discuss clinical conditions that are seen only in pregnant women and involve the liver; from Hyperemesis Gravidarum that happens in 1 out of 200 pregnancies and Intrahepatic Cholestasis of Pregnancy (0.5%-1.5% prevalence), to the more frequent condition of preeclampsia (10% prevalence) and its severe form; hemolysis, elevated liver enzymes, and a low platelet count syndrome (12% of pregnancies with preeclampsia), to the rare entity of Acute Fatty Liver of Pregnancy (incidence of 1 per 7270 to 13000 deliveries). Although pathogeneses behind the development of these aliments are not fully understood, theories have been proposed. Some propose the special physiological changes that accompany pregnancy as a precipitant. Others suggest a constellation of factors including both the mother and her fetus that come together to trigger those unique conditions. Reaching a timely and accurate diagnosis of such conditions can be challenging. The timing of the condition in relation toward which trimester it starts at is a key. Accurate diagnosis can be made using specific clinical findings and blood tests. Some entities have well-defined criteria that help not only in making the diagnosis, but also in classifying the disease according to its severity. Management of these conditions range from simple medical remedies to measures such as immediate termination of the pregnancy. In specific conditions, it is prudent to have expert obstetric and medical specialists teaming up to help improve the outcomes.

P-089 Upper limb deep vein thrombosis in pregnancy (ULDVT): Case report of 4 patients

P-089 Upper limb deep vein thrombosis in pregnancy (ULDVT): Case report of 4 patients

Anatomic Distribution of Deep Vein Thrombosis in Pregnancy

There is a high risk of pulmonary embolism (40%–50%) in patients with proximal deep vein thrombosis (DVT), and maternal morbidity and mortality may be high among women with untreated or unrecognized embolism. Evidence exists that the anatomic distribution of DVT in nonpregnant and pregnant patients may differ, with important clinical implications for optimizing diagnostic imaging protocols. In nonpregnant patients, prospective studies have shown that most DVTs of the lower extremity develop in the calf vein and further extend proximally; the majority of nonpregnant patients with a proximal thrombosis have involvement of the calf veins, and isolated proximal vein thrombi are uncommon. The typical anatomic distribution of DVT in pregnant patients is less clear. The primary aim of this systematic review of the medical literature was to determine the anatomic distribution of DVT of the lower extremity in symptomatic pregnant patients. Previously published studies of cohorts of pregnant women with DVT were examined using MEDLINE (1966–2009), Embase (1980–2009), and the Cochrane Library. Data were extracted from articles that were case series or observational cohorts of 3 or more participants, in which a DVT was diagnosed using objective techniques in unselected or consecutive pregnant women. In all, 6 articles meeting the criteria for inclusion were identified from an initial list of 1098 titles. A total of 124 women had been given a diagnosis of DVT; venography was used in 55 patients, whereas compression ultrasonography was the primary mode of diagnosis for 69 patients. The most common site for acute DVT was the proximal veins without involvement of calf veins (87/122; 71%); in 56 (64%) of these 87 patients, thrombosis was restricted to the iliac and/or femoral vein. Overall, 84 (88%) of the 96 patients (for whom the affected side was reported) had involvement of the left leg. These findings strongly suggest a difference in the anatomic distribution of DVT in pregnant versus nonpregnant women. The data confirm previous findings that, in contrast to the situation in nonpregnant individuals during pregnancy, most DVTs are proximal and restricted to the femoral or iliac veins, and most are on the left side.

Anticoagulant therapy for deep vein thrombosis (DVT) in pregnancy

Thromboembolic complications are much higher in pregnancy due to procoagulant changes. Heparin does not cross the placenta and the use of unfractionated heparin (UFH) is the current established practice in prophylaxis and treatment for thromboembolism in pregnancy. To compare the effectiveness of anticoagulant therapies for the treatment of deep vein thrombosis in pregnancy. The anticoagulant drugs included are UFH, low molecular weight heparin (LMWH) and warfarin. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2010) and reference lists of retrieved studies. Randomised controlled trials comparing any combination of warfarin, UFH, LMWH and placebo in pregnant women. We used methods described in the Cochrane Handbooks for Systemic Reviews of Interventions for assessing the eligibility of studies identified by the search strategy. A minimum of two review authors independently assessed each study. We did not identify any eligible studies for inclusion in the review.We identified three potential studies; after assessing eligibility, we excluded all three as they did not meet the prespecified inclusion criteria. One study compared LMWH and UFH in pregnant women with previous thromboembolic events and, for most of these women, anticoagulants were used as thromboprophylaxis. There were only three women who had a thromboembolic event during the current pregnancy and it was unclear whether the anticoagulant was used as therapy or prophylaxis. We excluded one study because it included only women undergoing caesarean birth. The third study was not a randomised trial. There is no evidence from randomised controlled trials on the effectiveness of anticoagulation for deep vein thrombosis in pregnancy. Further studies are required.