Merz Lauren E, Bassa Bibi, Ní Áinle Fionnuala, Fogerty Annemarie E
Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Hematology/Oncology, Department of Medicine, Mass General Brigham, Boston, Massachusetts, USA.
Royal College of Surgeons in Ireland, Dublin, Ireland; Division of Trauma and Emergency Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
J Thromb Haemost. 2025 Feb;23(2):417-428. doi: 10.1016/j.jtha.2024.09.029. Epub 2024 Oct 11.
Pregnancy is a prothrombotic state due to an estrogen-driven shift in the coagulation system, increased venous stasis, and external restriction of blood flow caused by the gravid uterus. Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in pregnancy. Preventing, recognizing, and treating thrombosis in pregnancy, as well as the postpartum period, often challenges decision making in the clinical setting. In early pregnancy, guidance with respects to thrombophilia testing and anticoagulation in increasing the likelihood of live birth among patients with recurrent miscarriages is evolving. This review explores emerging data that support clinical decision making in thrombosis care in women with common thrombotic complications in pregnancy. The first case outlines VTE diagnosis in pregnancy, initial anticoagulation management, management around delivery and postpartum, and subsequent long-term anticoagulation treatment. The second case examines testing for inherited and acquired thrombophilia in the setting of recurrent miscarriage and the management of obstetric antiphospholipid syndrome. Lastly, the third case reviews VTE risk assessment and prevention in pregnancy and the postpartum period, as well as duration and dose of postpartum thromboprophylaxis. Review of these common clinical scenarios surrounding thrombotic complications in pregnancy demonstrates recent advances in high-quality data, current gaps in knowledge, and variation in expert opinion. Ultimately, multidisciplinary discussion and teamwork remain key to optimal, safe care. Clinicians must prioritize collaborative, high-quality trials and prospective clinical management studies to better understand and define best practice in this population.
由于雌激素导致凝血系统发生变化、静脉淤滞增加以及妊娠子宫对血流的外部限制，妊娠是一种血栓前状态。静脉血栓栓塞（VTE）是妊娠期间发病和死亡的主要原因。在妊娠以及产后阶段预防、识别和治疗血栓形成，常常给临床决策带来挑战。在妊娠早期，关于血栓形成倾向检测和抗凝治疗以提高复发性流产患者活产可能性的指导意见正在不断发展。本综述探讨了新出现的数据，这些数据支持对患有妊娠常见血栓形成并发症的女性进行血栓形成护理的临床决策。第一个病例概述了妊娠期VTE的诊断、初始抗凝管理、分娩前后及产后管理以及随后的长期抗凝治疗。第二个病例研究了复发性流产情况下遗传性和获得性血栓形成倾向的检测以及产科抗磷脂综合征的管理。最后，第三个病例回顾了妊娠及产后阶段的VTE风险评估和预防，以及产后血栓预防的持续时间和剂量。对这些围绕妊娠血栓形成并发症的常见临床情况的综述表明，高质量数据有了新进展，目前存在知识空白，专家意见也存在差异。最终，多学科讨论和团队合作仍然是实现最佳安全护理的关键。临床医生必须优先开展协作性的高质量试验和前瞻性临床管理研究，以更好地理解和界定该人群的最佳治疗方法。
