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Prophylaxis And Screening Recommended For Pregnant Women At High Risk Of Venous Thromboembolism
A DGReview of :"Prediction, prevention, and treatment of venous thromboembolic disease in pregnancy"
Seminars in Thrombosis and Hemostasis
05/15/2003
By Deanna M. Green
Prophylactic treatment and genetic screening are recommended for women with a higher risk of venous thromboembolism (VTE) during pregnancy and the puerperium, according to a review by Dr. RB Zotz and colleagues from Düsseldorf, Germany.
Pregnancy is both an acquired and independent risk factor for VTE, and it is the primary cause of morbidity and mortality during pregnancy and the puerperium. Normal physiological changes in blood coagulation and fibrinolysis factors are required to prepare the body for the hemostatic stress of labor, but these changes can lead to VTE in high-risk women.
It is therefore important for physicians to assess the individual thrombotic risk during pregnancy based on known risk factors. Furthermore, it is necessary to develop a prophylactic protocol based on risk stratification to help prevent VTE during pregnancy.
Acquired risk factors for VTE during or after pregnancy include maternal age over 35 years, weight over 80 kg, 4 or more pregnancies, cesarean section, oral contraception use, and personal or family history of VTE.
Women with severe deficiencies in coagulation factors such as antithrombin or protein C have an intermediate to high risk of VTE and should receive heparin prophylaxis during pregnancy.
Furthermore, women who are carriers of mutations in either Factor V Leiden or prothrombin have about a 1 in 25 chance of thrombosis during pregnancy and the puerperium. Heparin prophylaxis is recommended for these women throughout the gestational period, or at least in the postpartum period.
Due to the low risk of VTE observed in women without prior thrombosis, routine screening of all pregnant women for congenital thrombophilia is not currently recommended. However, thrombophilia screening is recommended for women with a personal or family history of VTE.
Semin Thromb Hemost 2003 April;29:2:143-154.
"Prediction, prevention, and treatment of venous thromboembolic disease in pregnancy"
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