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Inherited Thrombophilia
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
On balance, anticoagulant therapy in women with thrombophilias does not appear to be efficacious for improving obstetric outcomes. However, there are scant high-quality data and definitive conclusions cannot be made. A prospective randomized, nonblinded non–placebo-controlled randomized trial evaluated the effect of thromboprophylaxis in women with one unexplained pregnancy loss at ≥10th week of amenorrhea and either heterozygous FVL mutation, prothrombin G20210A mutation, or PS deficiency (free antigen <55%) [69]. Women were given 5-mg folic acid daily before conception, to be continued during pregnancy, and either low-dose aspirin 100 mg daily or LMWH enoxaparin 40 mg starting at 8 weeks. LMWH was associated with a higher (86% vs. 29%) incidence of a healthy live birth, and lower incidence of low birthweight (10% vs. 30%). No significant side effects of the treatments could be evidenced in patients or newborns. This trial led to enthusiasm about the potential benefits of thromboprophylaxis. However, this was not a blinded trial and outcomes in untreated women were considerably worse than expected. Thus, results should be interpreted with caution.
Cesarean Delivery
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
A. Dhanya Mackeen, Meike Schuster
Pneumatic compression devices have been recommended based on retrospective data [69–72] and appear to be safe and effective [73]. While there are two RCTs on UH versus placebo, two RCTs of LMWH versus placebo, and four RCTs on LMWH versus UH given antenatally, the RCTs are, in general, small and the data are insufficient to make any recommendation [70, 71]. A meta-analysis that included seven RCTs showed no additional benefit with LMWH over UFH or control with respect to risk of VTE, but was associated with a higher risk of bleeding and hematomas [74]. It is not possible to assess the effects of any of these interventions on most outcomes, and especially on rare outcomes such as VTE, death, and osteoporosis, because of small sample sizes. There was some evidence of side effects associated with thromboprophylaxis. In summary, given the higher risk of VTE at CD compared with vaginal delivery, all women undergoing CD should receive at least mechanical VTE prophylaxis with either pneumatic compression devices or compression stockings [71]. These should be applied preoperatively and continued until full ambulation.
Prevention and Treatment of Venous Thromboembolism
Published in Paloma Tejero, Hernán Pinto, Aesthetic Treatments for the Oncology Patient, 2020
Although this is a controversial scenario, routine thromboprophylaxis is not usually considered necessary. Risk patients must be detected and classified based on chemotherapy and type of cancer. For this purpose, we have Khorana's predictive model [11]. According to Table 27.5, if the final score is 0, we are talking about a low-risk category; between 1 and 2, middle risk; and 3 or more, high risk. Based on the study analyses, it is usually deduced that low-molecular-weight heparins (LMWHs) reduce the incidence of VTED during chemotherapy, but with low repercussion [12]. However, if we focus on studies about high-risk patients, like CONKO 004 [13] or FRAGEM [14], in cases of advanced pancreatic cancer, the benefits of thromboprophylaxis with LMWHs during chemotherapy are clearly significant and clinically relevant.
Swedish obstetric thromboprophylaxis guideline: background and update
Published in Journal of Obstetrics and Gynaecology, 2023
Pelle G. Lindqvist, Eli Westerlund, Margareta Hellgren
Obstetric thromboprophylaxis consists of daily subcutaneous injections of low-molecular-weight heparin (LMWH), recommended due to the absence of placental transfer, thus avoiding effect on the foetus. Lifestyle advice is provided and compression stockings are recommended (Chauleur et al. 2008, Dargaud et al. 2009, Lindqvist and Hellgren 2011, Nelson-Piercy et al. 2015, Bates et al. 2018). Several thromboprophylaxis guidelines have been published (Chauleur et al. 2008, Dargaud et al. 2009, Lindqvist and Hellgren 2011, Nelson-Piercy et al. 2015, Sultan et al. 2016, Bates et al. 2018). Although some divide pregnant women into different risk groups (Nelson-Piercy et al. 2015, Bates et al. 2018), others apply weighted risk scores (Chauleur et al. 2008, Dargaud et al. 2009, Thrombosis Canada 2023). Thus, obstetric thromboprophylaxis regimens differ in different countries, and the extent of implementation also depends on the size of the population at risk (5% to 40%). There is an increasing risk of VTE throughout pregnancy, and the risk peaks during the first weeks postpartum. In this article, we present the basis for the Swedish algorithm for VTE risk estimation and management in women diagnosed as at moderate to high risk of VTE, as well as the most recent guideline update. This guideline is not designed for women with very high risk of VTE such as antithrombin (AT) deficiency, mechanical heart valves, antiphospholipid syndrome (APS) or those on chronic anticoagulant therapy.
Review spontaneous superior mesenteric artery aneurysm rupture following caesarean section: an uncommon event and review of current literature
Published in Journal of Obstetrics and Gynaecology, 2022
Mustafa Sengul, Halime Sen Selim
A 32-year-old gravida1 para 0 woman delivered her first girl baby with caesarean section (CS) because of the disproportions of the foetus and hip bone at 39 weeks of gestation. A lower segment section was applied without complication, and a live female newborn weighing 3250 g was delivered with an Apgar score of 9 at the 1st minute and 10 at the 5th minute. The estimated blood loss was 800 mL. The patient also had an unremarkable postoperative course and was discharged home on the 3rd postoperative day. Postoperative thromboprophylaxis was administered according to standard procedure. She denied any past medical, surgical, or family history, vaginal bleeding, decreased foetal movement, headache, abdominal pain, nausea, vomiting, or visual disturbances. The patient had routine prenatal care and her prenatal course had been uncomplicated thus far. Three days postpartum at her home, she complained of dizziness, lower abdominal pain, near-syncope. Her husband has called the emergency service.
High incidence of venous thromboembolism after acute cervical spinal cord injury in patients with ossification of the posterior longitudinal ligament
Published in The Journal of Spinal Cord Medicine, 2022
Nana Ichikawa, Gentaro Kumagai, Kanichiro Wada, Hitoshi Kudo, Toru Asari, Liu Xizhe, Yasuyuki Ishibashi
The incidence of VTE in the entire study population was 19.3%, but the incidence of VTE in the OPLL group was 50%. VTE has a reported incidence of 12%–64% in acute SCI and a mortality rate of 9.7%.1,8–11 Guidelines published by the Japanese Circulation Society classify motor paralysis in SCI as a high risk factor for VTE8 and recommend treatment with a foot/calf pump or low-dose unfractionated heparin to prevent VTE (except in cases with hematoma around the spinal cord or bleeding tendency). Liu et al.12 concluded that treatment with heparin provides effective thromboprophylaxis compared to no treatment. The VTE prevention guidelines published by the Consortium for Spinal Cord Medicine in 2016 recommend pharmacological prophylaxis for SCI patients; however, it should not be performed routinely for all patients without careful consideration.13 In our study, none of the patients were given prophylactic anticoagulants because of possible bleeding complications.