Inherited thrombophilia and pregnancy associated venous thromboembolism

doi:10.1136/bmj.39205.484572.55

BMJ 2007;334:1318-1321 (23 June), doi:10.1136/bmj.39205.484572.55

Practice

Pregnancy plus

Inherited thrombophilia and pregnancy associated venous thromboembolism

Wendy Lim, assistant professor¹, John W Eikelboom, associate professor², Jeffrey S Ginsberg, professor of medicine³

¹ Department of Medicine, McMaster University, St Joseph's Hospital, ² Department of Medicine, McMaster University, HGH McMaster Clinic, Hamilton, ON, L9K 1H8, Canada, ³ McMaster University Medical Center

Correspondence to: J W Eikelboom eikelbj@mcmaster.ca

The first 150 words of the full text of this article appear below.

Introduction

Pulmonary embolism is the leading cause of maternal mortalityin developed countries and accounts for 20% of pregnancy relateddeaths in the United States.¹ ² The risk of pulmonary embolismand deep vein thrombosis, collectively known as venous thromboembolism,is increased during pregnancy and is further increased by thepresence of inherited or acquired thrombophilias. We summarisethe epidemiology and diagnosis of venous thromboembolism inpregnancy and discuss the anticoagulant management of womenwith inherited thrombophilia who are at risk of, or who develop,venous thromboembolism during pregnancy and the postpartum period.

Scenario

A 30 year old woman, a known heterozygote for the factor VLeiden mutation, presents at eight weeks' gestation in her firstpregnancy wondering whether she should receive prophylacticanticoagulation to prevent recurrent venous thrombosis duringpregnancy. Several years ago she developed a deep vein thrombosisof the left leg after an ankle fracture and prolonged immobilisationand was . . . [Full text of this article]

Methods

How common are thromboembolic complications among pregnant women?

Non-inherited conditions that increase the risk of venous thromboembolismin pregnancy
General conditions^w2
Pregnancyrelated conditions

Does having an inherited thrombophilia affect pregnancy?

How are women at increased risk of thromboembolism managed during pregnancy?

Risk of venous thromboembolism

Risk of bleeding

Risk to the fetus

How is a thrombotic event managed during pregnancy?

How is anticoagulant therapy managed at the time of delivery?

Are there any management issues in the postpartum period?

Presenting signs and symptoms of venous thromboembolism in pregnancy
Legdeep vein thrombosis*
Pulmonaryembolism
Diagnostic tests for venous thromboembolism in pregnancy
Legdeep vein thrombosis
Pulmonaryembolism

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