VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy

Bates, Shannon M.; Greer, Ian A.; Middeldorp, Saskia; Veenstra, David L.; Prabulos, Anne-Marie; Vandvik, Per Olav

doi:10.1378/chest.11-2300

Cited by 1,525Venous Thromboembolism Diagnosis and ManagementBlood Coagulation and Thrombosis MechanismsPregnancy and preeclampsia studies

VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy

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Bates, Shannon M., Greer, Ian A., Middeldorp, Saskia, Veenstra, David L., Prabulos, Anne-Marie, Vandvik, Per Olav·2012·Chest

DOI 10.1378/chest.11-2300PMC PMC3278054

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Abstract

Background The use of anticoagulant therapy during pregnancy is challenging because of the potential for both fetal and maternal complications. This guideline focuses on the management of VTE and thrombophilia as well as the use of antithrombotic agents during pregnancy.Methods The methods of this guideline follow the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement.Results We recommend low-molecular-weight heparin for the prevention and treatment of VTE in pregnant women instead of unfractionated heparin (Grade 1B). For pregnant women with acute VTE, we suggest that anticoagulants be continued for at least 6 weeks postpartum (for a minimum duration of therapy of 3 months) compared with shorter durations of treatment (Grade 2C). For women who fulfill the laboratory criteria for antiphospholipid antibody (APLA) syndrome and meet the clinical APLA criteria based on a history of three or more pregnancy losses, we recommend antepartum administration of prophylactic or intermediate-dose unfractionated heparin or prophylactic low-molecular-weight heparin combined with low-dose aspirin (75-100 mg/d) over no treatment (Grade 1B). For women with inherited thrombophilia and a history of pregnancy complications, we suggest not to use antithrombotic prophylaxis (Grade 2C). For women with two or more miscarriages but without APLA or thrombophilia, we recommend against antithrombotic prophylaxis (Grade 1B).Conclusions Most recommendations in this guideline are based on observational studies and extrapolation from other populations. There is an urgent need for appropriately designed studies in this population.

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Low-molecular-weight heparins are a safe substitute for VKAs in pregnancy, as they do not cross the placenta.
“Low-molecular-weight heparins are a safe substitute, as they do not cross the placenta.923”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [923]

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Authors: Bates, S. M., Greer, I. A., Middeldorp, S., Veenstra, D. L., Prabulos, A.-M., & Vandvik, P. O.
Affiliations: Thrombosis and Atherosclerosis Research Institute (CA)
University of Liverpool (GB)
Amsterdam UMC Location University of Amsterdam (NL)
University of Washington (US)
University of Connecticut (US)
Innlandet Hospital Trust (NO)
ORCID: Bates, Shannon M.
Middeldorp, Saskia
Veenstra, David L.
Vandvik, Per Olav
Venue: Chest
Publisher: Elsevier BV
Published: 2012-02
Volume: 141
Issue: 2
Pages: e691S-e736S
ISSN: 0012-3692 (ISSN-L)
DOI: 10.1378/chest.11-2300
PMC: PMC3278054
OpenAlex: W2142237458
Cited by: 1,525
References: 369
Citations by year: 2026: 67 · 2025: 60 · 2024: 84 · 2023: 65 · 2022: 86 · 2021: 110 · 2020: 115 · 2019: 120 · 2018: 130 · 2017: 164 · 2016: 130 · 2015: 119 · 2014: 119 · 2013: 107 · 2012: 43
FWCI: 83.85
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: CHEST Journal (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Pure Amsterdam UMC (submittedVersion)
Funders: Bristol-Myers Squibb
Sanofi
National Heart, Lung, and Blood Institute (R13HL104758)
Topics: Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
Keywords: venous thromboembolism, thrombophilia, antithrombotic therapy, pregnancy, low molecular weight heparin, unfractionated heparin, vitamin K antagonists, antiphospholipid syndrome, inherited thrombophilia, anticoagulation during pregnancy, thromboprophylaxis
MeSH terms: Abortion, Spontaneous, Anticoagulants, Dose-Response Relationship, Drug, Female, Fibrinolytic Agents, Heparin, Heparin, Low-Molecular-Weight, Humans, Pregnancy, Pregnancy Complications, Cardiovascular, Risk Factors, Societies, Medical, Antiphospholipid Syndrome, Evidence-Based Medicine, Thrombophilia, Venous Thromboembolism, Secondary Prevention

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