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American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy
Open accessAbstract
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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“The ASH 2018 guidelines strongly recommend both antepartum and postpartum thromboprophylaxis in these patients, although this is based on low-certainty evidence [109].”
From Estrogen and thrombosis: a bench to bedside review (2020) · cites this paper as [109]
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Kearon, C., Leroyer, C., Mercier, B., Abgrall, J. F., Gal, G. L., Lacut, K., Oger, E., Bressollette, L., Férec, C., Lamure, M. P., et al. (2006) · Thrombosis and Haemostasis · doi:10.1160/th06-06-0328 · Cited by 41
Haapsamo, M., Martikainen, H. K., Tinkanen, H., Heinonen, S. T., Nuojua-Huttunen, S., & Rasanen, J. P. (2010) · Human Reproduction · doi:10.1093/humrep/deq286 · Cited by 41
Prolonged low-molecular-weight heparin use during pregnancy and subsequent bone mineral density
Galambosi, P. J., Hiilesmaa, V. K., Ulander, V., Laitinen, L., Tiitinen, A. E., & Kaaja, R. (2016) · Thrombosis Research · doi:10.1016/j.thromres.2016.05.016 · Cited by 39
Effect of In Utero Exposure of Iodinated Intravenous Contrast on Neonatal Thyroid Function
Hoshmand-Kochi, M., Kaloudis, E., Ahmed, W. O., & Moore, W. H. (2012) · Journal of Computer Assisted Tomography · doi:10.1097/rct.0b013e31824cc048 · Cited by 38
Effect of low dose heparin on blood loss at caesarean section
HILL, N. C. W., Hill, J. G., Sargent, J. M., Taylor, C. G., & Bush, P. (1988) · BMJ · doi:10.1136/bmj.296.6635.1505-a · Cited by 37
Bates, S. M., Alonso‐Coello, P., Tikkinen, K. A. O., Ebrahim, S., Lopes, L. C., McDonald, S. D., Zhou, Q. X., Akl, E. A., Neumann, I., Jacobsen, A. F., et al. (2015) · Thrombosis Research · doi:10.1016/j.thromres.2015.12.015 · Cited by 37
Self-citationMcDonnell, B. P., Glennon, K., McTiernan, A., O’Connor, H. D., Kirkham, C., Kevane, B., Donnelly, J. C., & Áinle, F. N. (2016) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-016-1409-5 · Cited by 37
Bhutia, S., & Wong, P. F. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003074.pub3 · Cited by 36
Stephenson, M. L., Serra, A. E., Neeper, J., Caballero, D., & McNulty, J. A. (2015) · Journal of Perinatology · doi:10.1038/jp.2015.130 · Cited by 35
Diagnosing cardiac disease during pregnancy: imaging modalities
Ntusi, N., Samuels, P., Moosa, S., & Mocumbi, A. O. (2016) · Cardiovascular journal of South Africa/Cardiovascular journal of Southern Africa · doi:10.5830/cvja-2016-022 · Cited by 35
Low-molecular-weight heparin to prevent postpartum venous thromboembolism
Phillips, P., Kahn, S. R., James, A., Konkle, B. A., Rodger, M. A., & for the PROSPER Investigators (2014) · Thrombosis and Haemostasis · doi:10.1160/th14-06-0485 · Cited by 34
Self-citationRisk of Venous Thromboembolic Events in Pregnant Patients With Autoimmune Diseases
Bleau, N., Patenaude, V., & Abenhaim, H. A. (2014) · Clinical and Applied Thrombosis/Hemostasis · doi:10.1177/1076029614553023 · Cited by 34
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Self-citationThrombophilia and venous thromboembolism in pregnancy: a meta-analysis of genetic risk
Ziakas, P. D., Poulou, L. S., Pavlou, M., & Zintzaras, E. (2015) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2015.06.005 · Cited by 33
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Hansen, A. T., Kesmodel, U. S., Juul, S., & Hvas, A. (2012) · Human Reproduction · doi:10.1093/humrep/des041 · Cited by 33
Flagged first, then by citations
3 of the 240 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Hassouna, 2010, Anticoagulation of pregnant women with mechanical heart valve prosthesis: a systematic review of the literature (2000-2009), J Coagul Disord, 2, 81
Cited by
Sorted by citations
Bikdeli, B., Madhavan, M. V., Jiménez, D., Chuich, T., Dreyfus, I., Driggin, E., Der-Nigoghossian, C. A., Ageno, W., Madjid, M., Guo, Y., et al. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.04.031 · Cited by 2,967
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Cuker, A., Tseng, E. K., Nieuwlaat, R., Angchaisuksiri, P., Blair, C., Dane, K., Davila, J., DeSancho, M. T., Diuguid, D., Griffin, D. O., et al. (2021) · Blood Advances · doi:10.1182/bloodadvances.2020003763 · Cited by 408
European Crohn’s and Colitis Guidelines on Sexuality, Fertility, Pregnancy, and Lactation
Torres, J., Chaparro, M., Julsgaard, M., Katsanos, K. H., Zelinková, Z., Agrawal, M., Ardizzone, S., Campmans-Kuijpers, M. J. E., Dragoni, G., Ferrante, M., et al. (2022) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjac115 · Cited by 294
Metadata
- 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
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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