Introduction

akusherstvo

Obstetrics, Gynecology and Reproduction

Акушерство, Гинекология и Репродукция

2313-73472500-3194

IRBIS LLC

10.17749/2313-7347/ob.gyn.rep.2021.222

akusherstvo-1125

Research Article

REVIEW ARTICLES

НАУЧНЫЕ ОБЗОРЫ

Prophylaxis and management of venous thromboembolism during pregnancy and postpartum period

Профилактика и лечение венозной тромбоэмболии при беременности и в послеродовом периоде

https://orcid.org/0000-0001-5353-205X

Хрыщанович

В. Я.

Khryshchanovich

V. Ya.

Хрыщанович Владимир Янович – доктор медицинских наук, профессор 2-й кафедры хирургических болезней

220116 Минск, пр. Дзержинского, д. 83

Scopus Author ID: 55791054400

Vladimir Ya. Khryshchanovich – MD, Dr Sci Med, Professor, Department of Surgical Diseases № 2

83 Dzerzhinsky Ave., Minsk 220116

Scopus Author ID: 55791054400

vladimirkh77@mail.ru

https://orcid.org/0000-0003-2267-579X

Скобелева

Н. Я.

Skobeleva

N. Ya.

Скобелева Наталья Яновна – аспирант кафедры акушерства и гинекологии, Белорусский государственный медицинский университет; врач акушергинеколог, заведующая акушерским отделением патологии беременности УЗ «Клинический родильный дом Минской области»

220116 Минск, пр. Дзержинского, д. 83,

20114 Минск, ул. Франциска Скорины, д. 16

Natalia Ya. Skobeleva – MD, Postgraduate Student, Department of Obstetrics and Gynecology, Belarussian State Medical University, Minsk, Republic of Belarus; Obstetrician-Gynecologist, Head of the Obstetric Department of Pregnancy Pathology, Clinical Maternity Hospital of Minsk Region

83 Dzerzhinsky Ave., Minsk 220116,

16 Frantsisk Skorina Str., Minsk 220114

Белорусский государственный медицинский университетРоссияBelarussian State Medical UniversityRussian Federation

Белорусский государственный медицинский университет; УЗ «Клинический родильный дом Минской области»РоссияBelarussian State Medical University; Clinical Maternity Hospital of Minsk RegionRussian Federation

2021

03112021

155599616

2021

Хрыщанович В.Я., Скобелева Н.Я.

Khryshchanovich V.Y., Skobeleva N.Y.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.gynecology.su/jour/article/view/1125

Introduction

Introduction. Venous thromboembolism (VTE) is one of the lead causes for maternal mortality and morbidity during pregnancy in the majority of developed countries. The incidence rate of VTE per pregnancy-year increases during pregnancy and postpartum period about by 4-fold and at least 14-fold, respectively.

Aim

Aim: to analyze and summarize current view on risk factors of thrombotic events during gestation and to discuss recent guidelines for the management of venous thromboembolic complications during pregnancy and postpartum, by taking into account a balance between risks and benefits of using anticoagulants.

Materials and Methods

Materials and Methods. The literature search covering the last 10 years was carried out in the electronic scientific databases RSCI, PubMed/MEDLINE, and Embase. While formulating a search strategy for evidence-based information, the PICO method (P = Patient; I = Intervention; C = Comparison; O = Outcome) and the key terms “venous thromboembolism” and “pregnancy” were used.

Results

Results. Risk factors were found to include a personal history of VTE, verified inherited or acquired thrombophilia, a family history of VTE and general medical conditions, such as immobilization, overweight, varicose veins, some hematological diseases and autoimmune disorders. VTE is considered being potentially preventable upon prophylactic administration of anticoagulants, but no high confidence randomized clinical trials comparing diverse strategies of thromboprophylaxis in pregnant women have been proposed so far. Because heparins do not cross the placenta, weight-adjusted therapeutic-dose low molecular weight heparins (LMWH) represent the anticoagulant treatment of choice for VTE during pregnancy. Once- and twice-daily dosing regimens are acceptable. However, no evidence suggesting benefits for measurement of factor Xa activities and consecutive LMWH dose adjustments to improve clinical outcomes are available. In case of uncomplicated pregnancy-related VTE, no routine administration of vitamin K antagonists, direct thrombin or factor Xa inhibitors, fondaparinux, or danaparoid is recommended. Lactating women may switch from applying LMWH to warfarin. Anticoagulation therapy should be continued for 6 weeks postpartum with total duration lasting at least for 3 months.

Conclusion

Conclusion. VTE is a challenging task in pregnant women expecting to apply a multi-faceted approach for its efficient solution by taking into account updated recommendations and personalized patient-oriented features.

Введение

Введение. Венозная тромбоэмболия (ВТЭ) является одной из ведущих причин материнской заболеваемости и смертности в перинатальном периоде в большинстве развитых стран. Во время беременности и после родов частота встречаемости ВТЭ возрастает в 4 и 14 раз соответственно.

Цель

Цель: провести анализ и систематизировать современные взгляды на факторы риска тромботических событий в период гестации, а также обсудить последние рекомендации по лечению и профилактике венозных тромбоэмболических осложнений (ВТЭО) при беременности и после родов c учетом баланса риска и пользы от назначения антикоагулянтов.

Материалы и методы

Материалы и методы. Библиографический поиск за последние 10 лет осуществляли в наукометрических базах данных РИНЦ, PubMed/MEDLINE, Embase. При формулировке стратегии поиска доказательной информации применяли метод PICO (англ. P = Patient; I = Intervention; C = Comparison; O = Outcome) и ключевые термины «венозный тромбоз/venous thromboembolism» и «беременность/pregnancy».

Результаты

Результаты. К факторам риска относятся индивидуальный или семейный анамнез ВТЭ, наличие наследственной или приобретенной тромбофилии, некоторые сопутствующие заболевания или состояния (иммобилизация, избыточный вес, варикозная болезнь, гематологическая патология, аутоиммунные расстройства). При профилактическом назначении антикоагулянтов развитие ВТЭ можно предотвратить, однако до сих пор отсутствуют рандомизированные клинические исследования с высокой степенью доказательности в отношении различных подходов к тромбопрофилактике у беременных. Поскольку гепарины не проникают через плацентарный барьер, препаратами выбора для лечения ВТЭ у беременных являются низкомолекулярные гепарины (НМГ) в терапевтической дозировке с поправкой на массу тела. Приемлемы как однократный, так и двукратный суточный режим введения НМГ. Убедительные данные, указывающие на преимущества подбора дозы НМГ по уровню активности Xa фактора, отсутствуют. В случаях неосложненной ВТЭ не рекомендуется рутинное назначение беременным антагонистов витамина К, прямых ингибиторов тромбина или Xa фактора, фондапаринукса и данапароидов. В период лактации допустим переход с НМГ на прием варфарина. Антикоагулянтную терапию следует продолжать в течение 6 нед после родов, а ее общая продолжительность должна быть не менее 3 мес.

Заключение

Заключение. Ведение беременных с ВТЭ является непростой задачей, эффективное решение которой предполагает дифференцированный подход с учетом актуальных рекомендаций и индивидуальных особенностей пациенток.

венозная тромбоэмболиябеременностьтромбофилияпрофилактикалечение

venous thromboembolismpregnancythrombophiliaprophylaxismanagement

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The authors declare that there are no conflicts of interest present.