Academic Medical Center, Department of Vascular Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Blood. 2011 Nov 17;118(20):5394-400. doi: 10.1182/blood-2011-04-306589. Epub 2011 Sep 14.
Venous thromboembolism (VTE) complicates ~ 1 to 2 of 1000 pregnancies, with pulmonary embolism being a leading cause of maternal mortality and deep vein thrombosis an important cause of maternal morbidity, also on the long term. However, a strong evidence base for the management of pregnancy-related VTE is missing. Management is not standardized between physicians, centers, and countries. The management of pregnancy-related VTE is based on extrapolation from the nonpregnant population, and clinical trial data for the optimal treatment are not available. Low-molecular-weight heparin (LMWH) in therapeutic doses is the treatment of choice during pregnancy, and anticoagulation (LMWH or vitamin K antagonists postpartum) should be continued until 6 weeks after delivery with a minimum total duration of 3 months. Use of LMWH or vitamin K antagonists does not preclude breastfeeding. Whether dosing should be based on weight or anti-Xa levels is unknown, and practices differ between centers. Management of delivery, including the type of anesthesia if deemed necessary, requires a multidisciplinary approach, and several options are possible, depending on local preferences and patient-specific conditions.
静脉血栓栓塞症（VTE）在每 1000 次妊娠中约有 1 至 2 例，其中肺栓塞是孕产妇死亡的主要原因，深静脉血栓形成也是导致孕产妇长期发病率的重要原因。然而，目前缺乏针对妊娠相关 VTE 管理的强有力证据基础。医生、中心和国家之间的管理不规范。妊娠相关 VTE 的管理是基于从非妊娠人群中推断出来的，并且没有关于最佳治疗的临床试验数据。在治疗剂量下，低分子肝素（LMWH）是妊娠期间的首选治疗药物，抗凝（LMWH 或维生素 K 拮抗剂产后）应持续至产后 6 周，总疗程至少为 3 个月。使用 LMWH 或维生素 K 拮抗剂不影响母乳喂养。基于体重或抗 Xa 水平进行给药的剂量尚不明确，且不同中心之间的做法存在差异。分娩的管理，包括如果需要的麻醉类型，需要采取多学科的方法，并且有几种可能的选择，具体取决于当地的偏好和患者的具体情况。
