Venous Thromboembolism In Pregnancy Research Articles

COVID-19 Vaccine Safety in Pregnancy, A Nested Case-Control Study in Births From April 2021 to March 2022, England.

Assessment of COVID-19 vaccine safety in pregnancy using population-based data. Matched case-control study nested in a retrospective cohort. April 2021-March 2022, England. All pregnant individuals aged between 18 and 50 years with valid health records. Individuals identified from the national Maternity Services Data Set (MSDS) had their records linked to hospital admission, national COVID-19 vaccine and COVID-19 testing databases. Matching included participant's age and estimated week of conception. We compared outcomes across multiple COVID-19 vaccine exposures using conditional multivariable logistic regression, adjusting for demographic and health characteristics. Adverse pregnancy, maternal and neonatal outcomes. 514 013 individuals were included. We found lower odds of giving birth to a baby who was low birthweight (aOR = 0.86, 95% CI: 0.79-0.93), preterm (aOR = 0.89, 95% CI: 0.85-0.92) or who had an Apgar score < 7 at 5 min of age (aOR = 0.89, 95% CI: 0.80-0.98) for individuals who received at least one dose of COVID-19 vaccine during pregnancy. The odds of admission to intensive care unit during pregnancy were lower in those vaccinated (aOR = 0.85, 95% CI: 0.76-0.95). There was no association between vaccination in pregnancy and stillbirth, neonatal death, perinatal death and maternal venous thromboembolism in pregnancy. COVID-19 vaccines are safe to use in pregnancy. Our findings generated important information to communicate to pregnant individuals and health professionals to support COVID-19 maternal vaccination programmes.

Venous Thromboembolism in Pregnancy: A Review of Diagnosis, Management, and Prevention.

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism, is a leading cause of maternal morbidity and mortality worldwide. Physiological changes that occur in a normal pregnancy increase the risk for VTE by 4-5-fold in the antepartum period and 30-60-fold in the immediate postpartum period. Compressive ultrasonography is the diagnostic test of choice for deep vein thrombosis. Both ventilation/perfusion scanning and computed tomography pulmonary angiography can reliably diagnose pulmonary embolism. Anticoagulation for a minimum of 3 months, typically with low molecular weight heparin, is the treatment of choice for pregnancy-associated VTE (PA-VTE). Despite the significant societal burden and potentially devastating consequences, there is a paucity of data surrounding the prevention of PA-VTE, resulting in major variations between international guidelines. This review will summarize the current recommendations for diagnosis, management, and prevention of PA-VTE.

Venous thromboembolism in pregnancy and postpartum: an illustrated review

The topic of this review is venous thromboembolism (VTE) during pregnancy and postpartum. The following topics will be addressed: epidemiology and pathophysiology of VTE in pregnancy and postpartum, diagnostic considerations for VTE in pregnancy, indications for prophylactic and therapeutic anticoagulation in pregnancy and postpartum, choice of anticoagulation in pregnancy and breastfeeding, anticoagulation management during labor and delivery, and anticoagulation considerations for assisted reproductive technology.

Fetomaternal Outcomes of Venous Thromboembolism in Pregnancy at Moi Teaching and Referral Hospital, Eldoret, Kenya

Fetomaternal Outcomes of Venous Thromboembolism in Pregnancy at Moi Teaching and Referral Hospital, Eldoret, Kenya

Diagnosis of Venous Thromboembolism in Pregnancy

Diagnosis of Venous Thromboembolism in Pregnancy

Diagnosis of Venous Thromboembolism in Pregnancy

Diagnosis of Venous Thromboembolism in Pregnancy

Update on venous thromboembolism in pregnancy

Update on venous thromboembolism in pregnancy

Delivering Evidence to Prevent Recurrent Venous Thromboembolism in Pregnancy

(Lancet. 2022;400:1743–1745) Pregnant and postpartum women have an increased risk for venous thromboembolism (VTE) (0 to 1%) with a history of VTE increasing the likelihood (2% to 10%). Hypercoagulability, endothelial damage, and venous stasis are contributing factors. Low–molecular-weight heparin (LMWH) thromboprophylaxis during pregnancy to 6 weeks postpartum is the recommended treatment for women with history of VTE, yet evidence-based dosage recommendations are lacking, causing dosage variation between countries and practices.

Venous Thromboembolism in Pregnancy: Challenges and Solutions.

Venous thromboembolism (VTE) is a serious medical condition that can lead to severe morbidity and mortality, making it a significant public health concern. VTE is a multifactorial condition that results from the interaction of genetic, acquired, and environmental factors. Physiological changes during pregnancy increase the risk of VTE as they express Virchow's triad (increased coagulation factors, decreased fibrinolysis, trauma, and venous stasis). Moreover, pregnancy-related risk factors, such as advanced maternal age, obesity, multiple gestations, and cesarean delivery, further increase the risk of VTE. Managing VTE in pregnancy is challenging due to the complexity of balancing the risks and benefits of anticoagulant therapy for both the mother and the fetus. A multidisciplinary approach involving obstetricians, hematologists, and neonatologists, is necessary to ensure optimal outcomes for both the mother and baby. This review aims to discuss the current challenges associated with VTE in pregnancy and identify potential solutions for improving outcomes for pregnant women at risk for VTE.

American Society of Hematology, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panamena de Hematología, Sociedad Peruana de Hematología, and SVH 2023 guidelines for diagnosis of venous thromboembolism and for its management in special populations in Latin America.

Implementation of international guidelines in Latin American settings requires additional considerations (ie, values and preferences, resources, accessibility, feasibility, and impact on health equity). The purpose of this guideline is to provide evidence-based recommendations about the diagnosis of venous thromboembolism (VTE) and its management in children and during pregnancy. We used the GRADE ADOLOPMENT method to adapt recommendations from 3 American Society of Hematology (ASH) VTE guidelines (diagnosis of VTE, VTE in pregnancy, and VTE in the pediatric population). ASH and 12 local hematology societies formed a guideline panel comprising medical professionals from 10 countries in Latin America. Panelists prioritized 10 questions about the diagnosis of VTE and 18 questions about its management in special populations that were relevant for the Latin American context. A knowledge synthesis team updated evidence reviews of health effects conducted for the original ASH guidelines and summarized information about factors specific to the Latin American context. In comparison with the original guideline, there were significant changes in 2 of 10 diagnostic recommendations (changes in the diagnostic algorithms) and in 9 of 18 management recommendations (4 changed direction and 5 changed strength). This guideline ADOLOPMENT project highlighted the importance of contextualizing recommendations in other settings based on differences in values, resources, feasibility, and health equity impact.

Ovarian torsion complicated with venous thromboembolism in pregnancy.

Ovarian torsion complicated with venous thromboembolism in pregnancy.

Assessment of Risk Factors and Risk Stratification for Venous Thromboembolism (VTE) in Pregnancy: A Study Conducted in A Tertiary Level Hospital

Background: Pregnancy itself is one of the most provoking factors for the development of venous thromboembolism (VTE) with an incidence of 5-12 per 10 000 pregnancies (from conception to delivery, i.e., 40 weeks) and 3-7 per 10 000 deliveries postpartum (6 weeks).1 Moreover, certain clinical conditions and individual patient profile make each pregnant women more susceptible to develop symptomatic VTE comprising deep vein thrombosis (DVT) and pulmonary embolism (PE). There is no denial of the fact that risk stratification based upon individual risk factors (both clinical and biochemical) during antenatal period will rationalize the implementation of precise antenatal care/ personalized prophylaxis tailored to each pregnant women, ultimately leading to safe and healthy maternal and perinatal outcome. Objective: The objective of this study is to apply the documented assessment scoring system according to the RCOG Guideline 37a mainly based on clinical risk factors to detect and stratify antenatal patient risk of VTE and institute appropriate preventive treatment/advice. Method: This is a prospective cross-sectional study involving 50 antenatal/pregnant women randomly selected over a period of 6 months undergoing antenatal care in Bangladesh Medical College. For the assessment of risk of VTE in these patients, RCOG guideline 37a risk assessment tool was used. (Appendix 1) A score ranging from 0 to 4 or more was objectively found among these patients. Based upon the score, each patient was categorized as high risk, intermediate risk, and lower risk. Then thromboprophylaxis with LMWH (Enoxaparin)/mobilization was advised for variable durations depending upon the timing of presentation and scores. The patients were reassessed after admission and post-delivery using the same tool for change in transient factors and advised according to the score. Implementation of this risk stratification tool resulted in improved patient care and counselling; the pregnancy outcome of each case was followed up. Results: Among the fifty antenatal patients, RCOG guideline 37a risk assessment tool revealed the following scores: one patient scored zero. Eighteen patients scored one. Sixteen patients scored two. Nine patients scored three. Six patients scored four. Those who scored 0 and 1 (19 patients) required no thromboprophylaxis. The sixteen patients with a score of two were advised for post-natal thromboprophylaxis with low molecular weight heparin/ Enoxaparin (LMWH) for 10 days. They were reassessed/ re-scored in the postnatal period for VTE risk and 5 of these patients down scored to one. Thereby they were judged as not to require post-natal thromboprophylaxis and were advised early mobilization and avoidance of dehydration. The remaining 11 patients with a score of two on postnatal review were put on LMWH (Enoxaparin) at a dose of 20 mg daily subcutaneous (s.c.) (&lt;50 kg), 40 mg daily (50-90 kg), 60 mg daily in 2 divided dose (91-130 kg) for 10 days. Conclusion: Pulmonary embolism is a dreaded consequence of VTE in pregnancy and post-partum, resulting in sudden severe maternal morbidity and mortality. Individualized scoring of the risk of VTE or early detection of DVT (deep venous thrombosis) with subsequent treatment /prophylaxis can reduce /eliminate the risk of maternal death related to VTE. Implementation of risk stratification for VTE of antenatal patients has resulted in a change of practice emphasising preventive measures such as mobilisation and anticoagulation according to the objective scoring system. It is clear that the antepartum and postpartum periods have different magnitudes of risk and distinct risk factors for VTE and therefore must be considered separately. As a continuum of care, carefully reviewed post-partum risk factors has also been proposed by the RCOG in the GTG 37a guideline. Low-molecular-weight heparin is safe in pregnancy and post-partum in prophylactic and therapeutic doses and does not require coagulation monitoring by haematological studies. LMW heparin provides advantages over heparin in that it has better bioavailability and longer half-life, simplified dosing, predictable anticoagulant response, lower risk of Heparin induced thrombocytopenia (HIT), and lower risk of osteoporosis. However, if monitoring is necessary particularly in case of ?Class II Obesity, renal insufficiency and presence of mechanical heart valves, anti–factor Xa levels must be measured because LMWH preparations have little effect on activated partial Thromboplastin Time (aPTT).

Fibrin monomer complex as a potential thrombosis marker related to venous thromboembolism risk in pregnant women.

Pregnancy is a risk factor for venous thromboembolism (VTE) due to increased coagulation factor activity and decreased protein S activity. However, thrombosis markers for predicting VTE in pregnancy remain controversial. This study aimed to investigate the relationship between VTE risk and thrombosis markers in pregnant women and to identify markers related to VTE risk. Archived plasma samples from 107 pregnant women were used in this study, and the concentrations of D-dimer, fibrin monomer complex (FMC), plasmin-plasmin inhibitor complex, prothrombin time, activated partial thromboplastin time, and fibrinogen were measured. VTE risk was scored according to the Royal College of Obstetricians and Gynaecologists green-top guidelines and the patients were divided into low- or high-risk groups. The median (range) of risk score for deep vein thrombosis was 2 (0-8), and we defined the high-risk group included those with a score of ≧3. D-dimer and FMC concentrations were significantly higher in the high-risk group than in the low-risk group (D-dimer 4.5 vs 2.6μg/mL, p = 0.008; FMC 14.6 vs 3.4μg/mL, p < 0.001). Although D-dimer concentration significantly increased with gestational age (Spearman's correlation coefficient [rs] = 0.317, p < 0.001), FMC concentration did not (rs = -0.081, p = 0.409). The area under the receiver operating characteristic curve values of D-dimer, FMC, and both D-dimer and FMC for the high-risk group were 0.656, 0.713, and 0.738, respectively. FMC may be a thrombosis marker related to VTE risk in pregnancy and is potentially preferable over D-dimer concentrations.

Antithrombin Deficiency: Frequency in Patients with Thrombosis and Thrombophilic Families

Purpose: Antithrombin (AT) deficiency is a well-known inherited risk factor for venous thromboembolism (VTE). However, F V Leiden and F II20210a mutations have drawn much more attention in the recent years. Therefore, we have decided to analyze the frequency of antithrombin deficiency in different cohorts of patients and tried to formulate indications for its testing. Results: Antithrombin deficiency was found in 4% of patients with recurrent VTE ≤ 50 years of age with, in 1% of patients with splanchnic vein thrombosis and in 2% of cases associated with combined oral contraceptives (COC) use or pregnancy. In patients with central venous thrombosis, antithrombin deficiency was not found. Recommendation: We consider antithrombin testing useful in patients with thrombosis occuring up to 45 years of age without any risk factors. Namely, females with VTE in pregnancy and puerperium should be tested as well as females with thrombosis on COC, if VTE occurred within the first year of their use. Conclusion: In spite of degressive interest in thrombophilia work up, we still consider antithrombin testing useful in defined clinical situations.

Venous thromboembolism in pregnancy and postpartum among women with physical disabilities

Venous thromboembolism in pregnancy and postpartum among women with physical disabilities

Anticoagulant use to treat VTE (venous thromboembolism) in pregnancy: a review

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a medical condition that occurs when a blood clot forms in a deep vein that major cause of pregnancy-related maternal death. As pregnancy progresses, the risk of hypercoagulability increases, fibrinogen, factors VII, VIII, X and VWF (Von Willebrand Factor), plasminogen activator inhibitor-1, plasminogen activator inhibitor-2 are increases and 40-60% protein S decreases. Therefore, anticoagulant drugs are the mainstay of therapy for patients with VTE. The review aimed to select the best anticoagulant for pregnancy women with VTE. A scoping review was used. The type of articles reviewed were original articles obtained from four electronic journal databases published within 2012-2021. The main therapeutic agent recommended for use in the prevention and treatment of VTE in pregnancy is low molecular weight heparin (LMWH). LMWH has better bioavailability than other anticoagulants, has a lower risk of maternal bleeding, thromboembolic, thrombocytopenia and osteoporosis. The use of LMWH is actually better, more comfortable and safety for patients.

Incidence of VTE in Pregnant Women with Sickle Cell Gene Mutation(s): A Retrospective Database Analysis

Purpose/Objective(s): The leading cause of pregnancy-associated mortality in Western countries is venous thromboembolism (VTE) with an absolute incidence of 0.025 to 0.1 percent in the general pregnant population. Noubiap et al reported that sickle cell disease (SCD) patients had a significantly higher risk for VTE (pooled OR 4.4, 95%CI 2.6-7.5, p < 0.001), deep vein thrombosis (DVT) (OR 1.1, 95% CI 1.1-1.2, p < 0.001) and pulmonary embolism (PE) (pooled OR 3.7, 95% CI 3.6-3.8, p < 0.001) as compared to patients without SCD [1]. Although sickle cell trait (SCT) and SCD have an increased risk for VTE, the incidence of VTE during pregnancy has not been documented. Our primary objective was to record a composite incidence of VTE among pregnant patients with SCT/SCD. Material/Methods: A retrospective, cross-sectional analysis including pregnant patients with SCT and SCD was conducted at our tertiary care academic medical center. Data was collected between January 2011 and December 2020. Adult women up to 51 years old with hemoglobin electrophoresis proven SCT and SCD were included. Risk factors for VTE such as the patient's body mass index (BMI), COVID status, family history of VTE, and smoking history were included in the analysis. ANOVA and Chi-square tests were used for analysis and to calculate a composite incidence, odds ratio, confidence interval, and p-value. A p-value of <0.05 was considered statistically significant. Data was analyzed using the SAS system. Results: A total of 139 pregnant SCT/SCD patients were included for analysis, out of which, the majority of the patients were SCT (84/139, 60.4%). The mean age at pregnancy was 26.42 (standard deviation 5.72). The type of VTE included DVT 58.3% (14/24) and PE 41.7% (10/24). At our facility, the incidence rate of VTE in pregnancy for SCT/SCD was 17% as compared to 0.025 to 0.1% in the general population. There was no statistically significant difference in the odds of developing VTE between SCD and SCT (OR= 1.09, 95% CI [.45, 2.63]). Only 2.16% of patients had positive COVID infection, as most of the collected data predated the pandemic. Almost one-third of the patients were smokers (45/139) and only 2.88% (4/139) had a family history of VTE. BMI was divided into BMI <30 (38.13%, 53/139) and BMI >30 (61.87%, 86/139). Obesity (OR= 1.03, 95% CI [.4166, 2.56]) and COVID status (OR=2.45, 95% CI [.21, 28.23]) were not found to be significant in our population of patients. Patients with a family history of DVT had a greater odd of developing VTE (OR=50.70, 95% CI [2.63, 977.88]), although the sample may not provide a precise representation of the population mean. Conclusion: Currently, ASH guidelines recommend a conservative approach to VTE prophylaxis unless research suggests benefits [2]. Our analysis found a 17% incidence of pregnancy-associated VTE in our SCT/SCD patients, which is drastically higher than the general population. With such a significant increased incidence in this patient population, especially with current racial disparities in African American maternal mortality rates, more research should be conducted to evaluate the need for thromboprophylaxis/treatment. Additionally, evaluation for specific SCT/SCD guidelines and recommendations to decrease pregnancy-related VTE and mortality rates should be discussed.

Delivering evidence to prevent recurrent venous thromboembolism in pregnancy.

Compared with non-pregnant women, pregnant women and women in the post-partum period until 12 weeks have a 4–5-times increased risk of venous thromboembolism, with an incidence of approximately 0·1%.1 Women with a previous venous thromboembolism have higher risks (2–10%) of recurrent venous thromboembolism in pregnancy and post partum than do other women.2 Increased venous thromboembolism risks are due to physiological changes in pregnancy contributing to all three components of Virchow's triad: hypercoagulability, stasis of flow, and endothelial damage.

Management of Antithrombin Deficiency in Pregnancy.

Antithrombin (AT) deficiency is a high-risk thrombophilia and a rare condition. The risk of venous thromboembolism (VTE) is increased in AT-deficient women during pregnancy and the postpartum period and is especially high in women with a prior history of VTE. A thorough assessment of VTE risk is recommended in pregnant AT-deficient women, comprising the degree and type of AT deficiency, genetic mutations, personal and family history, and additional preexisting or pregnancy-specific risk factors. Due to a lack of adequate study data, there is limited guidance on the management of AT deficiency in pregnancy, including the need for prophylactic anticoagulation, the appropriate dose of low-molecular-weight heparin (LMWH), and the role of AT substitution. LMWH is the medication of choice for the pharmacological prophylaxis and treatment of VTE in pregnancy. Patients with a history of VTE should receive full-dose LMWH during pregnancy and the postpartum period. AT concentrates are a treatment option when anticoagulation is withheld in potentially high-risk events such as childbirth, bleeding, or surgery and in cases of acute VTE despite the use of therapeutic dose anticoagulation. Women with AT deficiency should be counseled at specialized centers for coagulation disorders or vascular medicine, and close cooperation between obstetricians and anesthesiologists is warranted before delivery and during the peripartum period.

Risk assessment models for venous thromboembolism in pregnancy and in the puerperium: a systematic review

ObjectivesTo assess the comparative accuracy of risk assessment models (RAMs) to identify women during pregnancy and the early postnatal period who are at increased risk of venous thromboembolism (VTE).DesignSystematic review...