Management of deep-vein thrombosis in pregnancy

Abstract

Introduction: Pregnancy and puerperium are well-established risk factors for deep-vein thrombosis (DVT) and pulmonary embolism (PE), which are collectively referred to as venous thromboembolism (VTE). Objectives: Treatment of VTE in pregnant patients is unique in several ways. A subset of pregnant patients requires anticoagulation during pregnancy and/or in the postpartum period, including women at high risk of DVT and some women with fetal loss. Materials and Methods: It was a retrospective study of all DVT patients with pregnancy, referred to the vascular surgery department of a tertiary care hospital from December 2015 to November 2019. Results: A total of 56 DVT patients with pregnancy were admitted in the vascular surgery department during the above period. Sixteen of them had a past history of DVT in previous pregnancy. Thirty-two patients presented in the first trimester, 14 in the second trimester, and 10 in the third trimester of pregnancy. Eight of them had associated PE and managed with intensive care unit care. All patients were managed with long-term anticoagulant with low-molecular-weight heparin. Conclusion: Use of anticoagulants during pregnancy is challenging due to the potential teratogenic effects and dosing complexities of the various agents and the management of anticoagulation during the time of labor. 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.