Deep vein thrombosis and pulmonary embolism in pregnancy: Prevention
- David R Schwartz, MD
David R Schwartz, MD
- Associate Professor of Clinical Medicine
- Section Chief, Critical Care
- NYU Medical Center
- Atul Malhotra, MD
Atul Malhotra, MD
- Kenneth M Moser Professor, Department of Medicine
- University of California, San Diego
- Steven E Weinberger, MD
Steven E Weinberger, MD
- Adjunct Professor of Medicine
- University of Pennsylvania School of Medicine
- Executive Vice President and CEO
- American College of Physicians
- Section Editors
- Lawrence LK Leung, MD
Lawrence LK Leung, MD
- Editor-in-Chief — Hematology
- Section Editor — Disorders of Hemostasis and Coagulation
- Professor of Medicine
- Stanford University School of Medicine
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Jess Mandel, MD
Jess Mandel, MD
- Section Editor — Pulmonary Vascular Disease
- Professor of Medicine
- University of California, San Diego
Pregnancy and the puerperium are well-established risk factors for deep vein thrombosis (DVT) and pulmonary embolism (PE), which are collectively referred to as venous thromboembolic disease (VTE). The need for thromboprophylaxis should be assessed antepartum, postpartum and at any time the patient transitions from the outpatient to the inpatient setting. When it is determined that thromboprophylaxis is warranted, an appropriate strategy should be selected and prescribed.
Thromboprophylaxis can be pharmacologic (ie, anticoagulation) or mechanical (eg, intermittent pneumatic compression devices or graduated compression stockings). Indications, method and duration of thromboprophylaxis in pregnant women are the major focuses of this topic. Issues concerning the use of anticoagulants during pregnancy and prevention of VTE in medical, surgical, and gynecologic patients are discussed separately. (See "Use of anticoagulants during pregnancy and postpartum" and "Prevention of venous thromboembolic disease in acutely ill hospitalized medical adults" and "Prevention of venous thromboembolic disease in surgical patients".)
Pregnancy and the puerperium are risk factors for the development of venous thromboembolism (VTE). This risk is thought to be due to venous stasis of the lower extremities, endothelial injury and the hypercoagulable state that occurs during pregnancy. The incidence VTE is increased throughout all trimesters of pregnancy but is highest during the postpartum period. Factors that may further augment the risk include a prior history of VTE, hospitalization for an acute illness or cesarean delivery, and the presence of an inherited thrombophilia (eg, factor V Leiden mutation prothrombin gene mutation, antithrombin III, protein C, or protein S deficiencies). (See "Deep vein thrombosis in pregnancy: Epidemiology, pathogenesis, and diagnosis", section on 'Pathogenesis'.)
Although pregnancy and the puerperium are risk factors for the development of VTE, the vast majority of pregnant women do not require thromboprophylaxis. However, thromboprophylaxis is typically targeted at those who are considered to be at greatest risk for the development of VTE during the antepartum and postpartum periods. The indications for thromboprophylaxis in this particular population of patients are discussed in this section.
Outpatient thromboprophylaxis — The indications for thromboprophylaxis differ for antepartum and postpartum women.
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