Summary
Aim: Overview on pathogenesis, prophylaxis and therapy of thromboembolic complications.
Methods: Literature search in Pubmed.
Results and discussion: In pregnancy, changes in plasma coagulation favour the procoagulant properties to prevent blood loss during delivery. Venous thromboembolism is still one of the leading causes of serious maternal morbidity and mortality in the western world. The risk of developing venous thromboembolism (VTE) is 4–5-fold higher during pregnancy and twenty times higher postnatal. Vascular complications such as deep vein thrombosis (DVT) and pulmonary embolism may occur in pregnancy, especially in patients with acquired or hereditary thrombophilia, as well as recurrent abortion in patients with antiphospholipid syndrome. Recommendations concerning the necessity of prophylactic low molecular weight heparin (LMWH) are made individually, depending on the type of thrombophilia and past medical or family histories of deep vein thrombosis, pulmonary embolism or recurrent abortion, as well as the course of pregnancy. There is no general recommendation for prophylactic heparinisation in patients with asymptomatic thrombophilia. LMWHs are the standard anticoagulants for thromboembolism in pregnancy, as they have few side effects and are not teratogenic. Anticoagulation for acute VTE should usually be given for six weeks after delivery and for a total of at least three months. Additionally, acetylsalicylic acid (75–100 mg/day) is recommended for patients with antiphospholipid syndrome. As DVT in pregnancy often occurs in proximal veins, the risk of post-thrombotic syndrome is high. Prophylaxis appropriate to individual risk and early diagnosis is important to mini-mise short- and long-term complications of thromboembolism in pregnancy.
English version available at: www.phlebologieonline.de
Keywords
Deep vein thrombosis - thromboembolism - thrombophilia - pregnancy
