Document Detail


VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
MedLine Citation:
PMID:  22315276     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Shannon M Bates; Ian A Greer; Saskia Middeldorp; David L Veenstra; Anne-Marie Prabulos; Per Olav Vandvik;
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Publication Detail:
Type:  Journal Article; Practice Guideline    
Journal Detail:
Title:  Chest     Volume:  141     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-08     Completed Date:  2012-04-13     Revised Date:  2013-10-24    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e691S-736S     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada. batesm@mcmaster.ca
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MeSH Terms
Descriptor/Qualifier:
Abortion, Spontaneous / blood,  prevention & control
Anticoagulants / adverse effects,  therapeutic use
Antiphospholipid Syndrome / blood,  complications,  drug therapy
Dose-Response Relationship, Drug
Evidence-Based Medicine*
Female
Fibrinolytic Agents / adverse effects*,  therapeutic use*
Heparin / adverse effects,  therapeutic use
Heparin, Low-Molecular-Weight / adverse effects,  therapeutic use
Humans
Pregnancy
Pregnancy Complications, Cardiovascular / drug therapy*,  prevention & control*
Recurrence / prevention & control
Risk Factors
Societies, Medical*
Thrombophilia / drug therapy*
Venous Thromboembolism / drug therapy*,  prevention & control*
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 0/Heparin, Low-Molecular-Weight; 9005-49-6/Heparin
Comments/Corrections
Comment In:
Chest. 2012 Aug;142(2):545; author reply 545-6   [PMID:  22871781 ]
J Thromb Haemost. 2013 Sep;11(9):1782-4   [PMID:  23819793 ]
J Thromb Haemost. 2013 Sep;11(9):1779-81   [PMID:  23789890 ]

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