Pregnancy-associated VTE

JACC Focus Seminar on recommended guidelines and patient-centric management

MAIN TAKEAWAY

  • The choice of anticoagulation therapy in pregnant patients must account for baseline and pregnancy-specific clinical parameters (gestational age and risk of maternal/fetal complication peri-delivery)
    • Therapeutic management of pregnancy-associated VTE should involve a dynamic approach of combining guideline recommendations and individualised patient preferences

WHY THIS MATTERS

  • Pregnancy-associated VTE increases the risk of maternal mortality
    • The state of pregnancy creates a prothrombotic environment, creating the need for cautious diagnostic screening due to the inherent potential for altered test interpretation (related to sensitivity/specificity) vs the nonpregnant population

KEY HIGHLIGHTS

  • Key pregnancy-specific risk factors:
    • Gestational age (80-fold higher risk in the first 2 to 6 postpartum weeks)
    • Multiple gestation
    • Artificial reproductive technology (associated VTEs mostly seen in the first trimester)
    • Preeclampsia (increases deep venous thrombosis risk in the postpartum period)
    • Postpartum infection
  • Diagnosis: risk vs benefit assessment is recommended to confirm VTE diagnosis for prompt initiation of therapy
    • Deep venous thrombosis (symptomatic pregnant woman): venous duplex ultrasonography is still the standard of care
    • Pulmonary embolism: thoracic imaging (computed tomography pulmonary angiogram and chest magnetic resonance angiography)
  • Treatment: A personalized therapeutic approach, considering both the maternal and fetal health, is recommended and all pregnant patients diagnosed with VTE should be treated with systemic anticoagulant therapy
    • Inferior vena cava filter may be a treatment option for patients who are intolerant to anticoagulant therapy or have a contraindication to systemic anticoagulation
    • Invasive therapeutic options could be lifesaving for the pregnant women, but the associated risk of fetal morbidity and mortality is noteworthy

    Nichols KM, Henkin S, Creager MA. Venous thromboembolism associated with pregnancy. JACC Focus Seminar. J Am Coll Cardiol. 2020;76(18):2128-2141. doi: 10.1016/j.jacc.2020.06.090.

MAT-BH-2100640/v1/Jul 2021