Cited by 636Venous Thromboembolism Diagnosis and ManagementBlood Coagulation and Thrombosis MechanismsCerebral Venous Sinus Thrombosis

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American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy

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Bates, Shannon M., Rajasekhar, Anita, Middeldorp, Saskia, McLintock, Claire, Rodger, Marc A., James, Andra H., Vazquez, Sara R., Greer, Ian A., Riva, John J., Bhatt, Meha, Schwab, Nicole, Barrett, Danielle, LaHaye, Andrea, Rochwerg, Bram·2018·Blood Advances

DOI 10.1182/bloodadvances.2018024802PMC PMC6258928

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Abstract

BACKGROUND: Venous thromboembolism (VTE) complicates ∼1.2 of every 1000 deliveries. Despite these low absolute risks, pregnancy-associated VTE is a leading cause of maternal morbidity and mortality. OBJECTIVE: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and others in decisions about the prevention and management of pregnancy-associated VTE. METHODS: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations. RESULTS: The panel agreed on 31 recommendations related to the treatment of VTE and superficial vein thrombosis, diagnosis of VTE, and thrombosis prophylaxis. CONCLUSIONS: There was a strong recommendation for low-molecular-weight heparin (LWMH) over unfractionated heparin for acute VTE. Most recommendations were conditional, including those for either twice-per-day or once-per-day LMWH dosing for the treatment of acute VTE and initial outpatient therapy over hospital admission with low-risk acute VTE, as well as against routine anti-factor Xa (FXa) monitoring to guide dosing with LMWH for VTE treatment. There was a strong recommendation (low certainty in evidence) for antepartum anticoagulant prophylaxis with a history of unprovoked or hormonally associated VTE and a conditional recommendation against antepartum anticoagulant prophylaxis with prior VTE associated with a resolved nonhormonal provoking risk factor.

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Authors: Bates, S. M., Rajasekhar, A., Middeldorp, S., McLintock, C., Rodger, M. A., James, A. H., Vazquez, S. R., Greer, I. A., Riva, J. J., Bhatt, M., Schwab, N., Barrett, D., LaHaye, A., & Rochwerg, B.
Affiliations: Thrombosis and Atherosclerosis Research Institute (CA)
University of Florida Health (US)
Amsterdam UMC Location University of Amsterdam (NL)
Auckland City Hospital (NZ)
University of Ottawa (CA)
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, NC;
University of Utah (US)
Queen's University Belfast (GB)
McMaster University (CA)
University of Toronto (CA)
Wake Forest University (US)
Alexandria, VA; and
ORCID: Bates, Shannon M.
Middeldorp, Saskia
McLintock, Claire
Rodger, Marc A.
Vazquez, Sara R.
Riva, John J.
Bhatt, Meha
Rochwerg, Bram
Venue: Blood Advances
Publisher: American Society of Hematology
Published: 2018-11-27
Volume: 2
Issue: 22
Pages: 3317-3359
ISSN: 2473-9529 (ISSN-L)
2473-9537
DOI: 10.1182/bloodadvances.2018024802
PMC: PMC6258928
OpenAlex: W2903022860
Cited by: 625
References: 240
Citations by year: 2026: 94 · 2025: 89 · 2024: 90 · 2023: 79 · 2022: 81 · 2021: 86 · 2020: 70 · 2019: 33 · 2018: 2
FWCI: 45.21
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc-nd
Locations: Blood Advances (publishedVersion, cc-by-nc-nd)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Pure Amsterdam UMC (submittedVersion, other-oa)
Topics: Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
Health Sciences › Medicine › Clinical Neurology › Cerebral Venous Sinus Thrombosis
Keywords: venous thromboembolism, pregnancy, thromboprophylaxis, low molecular weight heparin, unfractionated heparin, anti-factor Xa monitoring, superficial thrombophlebitis, VTE diagnosis, maternal morbidity, anticoagulant dosing
MeSH terms: Administration, Oral, Anticoagulants, Breast Feeding, Female, Fibrinolytic Agents, Heparin, Low-Molecular-Weight, Humans, Infant, Infant, Newborn, Pregnancy, Evidence-Based Medicine, Venous Thromboembolism

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American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy

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