Venous thromboembolism in pregnancy: therapeutic options
DOI:
https://doi.org/10.52692/1857-0011.2025.2-82.44Keywords:
venous thromboembolism, pregnancy, anticoagulant management, deep vein thrombosis, pulmonary embolismAbstract
Introduction. Venous thromboembolism is a rare but significant cause of maternal morbidity and mortality during pregnancy and postpartum, affecting 1 in 1,000-2,000 pregnancies. Despite advancements in the treatment of venous thromboembolism in the general population, its management during pregnancy remains a challenge due to therapeutic limitations and the risks associated with anticoagulants for both the mother and the fetus. Prevention and treatment predominantly rely on the use of unfractionated heparin or low-molecular-weight heparin, which, while effective, are associated with maternal and fetal risks such as thrombocytopenia, osteoporosis, and neonatal bleeding. Methods. The study included original articles from specialized journals such as PubMed, Cochrane Library, and Google Scholar, focusing on venous thromboembolism, deep vein thrombosis, and pulmonary embolism during pregnancy. Articles on superficial venous thrombosis, arterial thrombosis, and other uncommon locations were excluded. The search strategy used controlled terms and relevant keywords. Results. Venous thromboembolism is the leading cause of maternal mortality in developed countries, with a postpartum risk of pulmonary embolism up to 35 times higher than during the antepartum period. Pregnancy-specific hypercoagulability is influenced by physiological factors such as increased levels of fibrinogen and coagulation factors. Hemostatic changes, mechanical compression of pelvic veins, and venous stasis contribute to the predisposition for venous thromboembolism. Anticoagulant treatments such as low-molecular-weight heparin and unfractionated heparin are most commonly used, involving distinct therapeutic phases: initial, primary, and extended, each with specific objectives in preventing venous thromboembolism recurrence. Conclusions. Managing venous thromboembolism during pregnancy requires personalized approaches that balance the risks and benefits of anticoagulation. Improving treatment strategies depends on further research to evaluate the safety and efficacy of new anticoagulants, particularly during pregnancy and postpartum.
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