Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands.
Semin Thromb Hemost. 2013 Jul;39(5):549-58. doi: 10.1055/s-0033-1343893. Epub 2013 Apr 30.
Pregnancy and the postpartum period are associated with an increased risk of venous thromboembolism (VTE), which complicates 1 to 2 of 1,000 pregnancies and represents a leading cause of mortality during pregnancy in developed countries. Strong evidence for the management of pregnancy-related VTE is missing, mostly because pregnant women have been excluded from all major trials investigating different diagnostic tools and treatment regimens. Nevertheless, proper evaluation of the involved risk factors is mandatory to reduce the incidence of pregnancy-related VTE and improve outcomes. Low-molecular-weight heparins are considered as a first-line option in the management of pregnancy-related VTE. With regard to future research, there is a need for methodologically strong studies in pregnant women, especially with respect to risk stratification, optimal heparin doses, usefulness of anti-FXa levels and their correlation with clinical outcomes, and correct management of anticoagulation during delivery.
妊娠和产后期间与静脉血栓栓塞症(VTE)的风险增加相关,每 1000 次妊娠中就有 1 至 2 次会发生这种情况,在发达国家,VTE 是导致妊娠期间死亡的主要原因。由于所有主要的试验都排除了孕妇,因此缺乏针对妊娠相关 VTE 的管理的有力证据,这些试验旨在调查不同的诊断工具和治疗方案。尽管如此,为了降低妊娠相关 VTE 的发生率并改善结局,对相关风险因素进行适当的评估是必不可少的。低分子量肝素被认为是妊娠相关 VTE 管理的一线选择。在未来的研究中,特别是在风险分层、最佳肝素剂量、抗 FXa 水平的有用性及其与临床结局的相关性以及分娩期间抗凝的正确管理方面,需要在孕妇中开展方法学上强大的研究。