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Hamostaseologie 2020; 40(05): 572-590
DOI: 10.1055/a-1132-0750
Review Article

Prevention of Venous Thromboembolism during Pregnancy and the Puerperium with a Special Focus on Women with Hereditary Thrombophilia or Prior VTE—Position Paper of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH)

Christina Hart
1   Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
,
Rupert Bauersachs
2   Department of Vascular Medicine, Klinikum Darmstadt GmbH, Darmstadt, Germany
3   Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
,
Ute Scholz
4   MVZ Labor Dr. Reising-Ackermann und Kollegen, Zentrum für Blutgerinnungsstörungen, Leipzig, Germany
,
Rainer Zotz
5   Centrum für Blutgerinnungsstörungen und Transfusionsmedizin, Düsseldorf, Germany
,
Frauke Bergmann
6   MVZ Wagnerstibbe, Amedes-Gruppe, Hannover, Lower Saxony, Germany
,
Hannelore Rott
7   Gerinnungszentrum Rhein-Ruhr, Duisburg, Germany
,
Birgit Linnemann
8   Division of Angiology, University Center of Vascular Medicine, University Hospital Regensburg, Regensburg, Germany
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Abstract

Venous thromboembolism (VTE) is a major cause of maternal morbidity during pregnancy and the postpartum period. Because there is a lack of adequate study data, management strategies for the prevention of VTE during pregnancy have mainly been deduced from case–control and observational studies and extrapolated from recommendations for non-pregnant patients. The decision for or against pharmacologic thromboprophylaxis must be made on an individual basis weighing the risk of VTE against the risk of adverse side effects such as severe bleeding complications. A comprehensive, multidisciplinary approach is often essential as the clinical scenario is made more complex by the specific obstetric context, especially in the peripartum period. As members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH), we summarize the evidence from the available literature and aim to establish a more uniform strategy for VTE risk assessment and thromboprophylaxis in pregnancy and the puerperium. In this document, we focus on women with hereditary thrombophilia, prior VTE and the use of anticoagulants that can safely be applied during pregnancy and the lactation period.

Keywords

venous thromboembolism - thromboprophylaxis - pregnancy - postpartum - risk assessment - heparin


Publication History

Received: 14 June 2019

Accepted: 25 February 2020

Article published online:
26 June 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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