Žilní tromboembolismus a antikoagulační léčba v těhotenství
| Title in English | Venous thromboembolism and anticoagulation therapy in pregnancy |
|---|---|
| Authors | |
| Year of publication | 2022 |
| Type | Article in Periodical |
| Magazine / Source | Remedia |
| MU Faculty or unit | |
| Citation | |
| Web | https://www.remedia.cz/rubriky/prehledy-nazory-diskuse/zilni-tromboembolismus-a-antikoagulacni-lecba-v-tehotenstvi/ |
| Keywords | pregnancy; venous thromboembolism; anticoagulant treatment |
| Description | Pregnancy - related venous thromboembolism (VTE), which included deep vein thrombosis (DVT) and pulmonary embolism (PE), remains one of the leading causes of maternal death during pregnancy in developed countries, despite the use of thromboprophylaxis in women at increased risk. About half of pregnancy-related VTE episodes occur during pregnancy, with a more or less similar distribution among trimesters, and the other half within the six weeks postpartum. The highest risk of VTE is present immediately after delivery, the daily absolute risk being higher in the postpartum period because the antepartum period lasts much longer. The diagnostic management of pregnancy-related VTE remains challenging. Current recommendations vary widely in the approach to diagnosing PE in pregnancy, as they are based on scarce and weak evidence. Low molecular weight heparin (LMWH) is the first-line anticagulant treatment in pregnancy. It should be continued until six weeks postpartum and for at least three months. Women who wish to breastfeed should avoid direct oral anticoagulants. Management of delivery needs a multidisciplinary approach in order to decide on an optimal delivery plan. Regional anesthesia can be administered in most patients, provided that the time window since the last dose of LMWH is respected. Women with a history of VTE are at risk of recurrence during pregnancy and in the postpartum period. |