Research progress on diagnosis and prevention strategies of pregnancy associated venous thromboembolism

doi:10.3760/cma.j.issn.1007-1245.2024.06.012

Abstract

Abstract:

Pregnancy associated venous thromboembolism (PA-VTE) is currently one of the main causes of maternal mortality. PA-VTE is a disease in which abnormal blood clotting occurs in the venous vessels of women during pregnancy and postpartum period, causing venous blood reflux disorders. Due to the complex diagnosis and prevention of PA-VTE in pregnant and postpartum women, in order to avoid delay in the diagnosis of PA-VTE and adverse consequences of inadequate prevention and treatment strategies, this article reviews the diagnosis and prevention strategies of PA-VTE.

Key words:

Pregnancy, Venous thromboembolism, Diagnosis and treatment methods, Preventive strategies, Progress

摘要：

妊娠相关静脉血栓栓塞症（pregnancy associated venous thromboembolism，PA-VTE）是目前孕产妇死亡的主要原因之一，PA-VTE为女性妊娠期及产褥期血液在静脉血管内出现异常的凝结，引起静脉血液回流障碍的一种疾病。由于妊娠期和产褥期孕产妇PA-VTE诊断和防治的复杂化，为避免PA-VTE诊断的延误以及不充足的防治策略所产生的不良后果，本文对PA-VTE的诊断和防治策略等方面进行综述。

关键词:

妊娠, 静脉血栓栓塞症, 诊疗方式, 预防策略, 进展

Wang Yuwei, Li Rui, Liu Chao, Liang Kuixiang.

Research progress on diagnosis and prevention strategies of pregnancy associated venous thromboembolism [J]. International Medicine and Health Guidance News, 2024, 30(6): 940-945.

王宇威李瑞刘超梁葵香.

妊娠相关静脉血栓栓塞症的诊断和防治策略研究进展 [J]. 国际医药卫生导报, 2024, 30(6): 940-945.

References

[1] Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis[J]. Lancet Glob Health, 2014, 2(6): e323-e333. DOI: 10.1016/S2214-109X(14)70227-X.
[2] Andrew L, Ní Áinle F, Blondon M, et al. Preventing postpartum venous thromboembolism: a call to action to reduce undue maternal morbidity and mortality[J]. Thromb Res, 2020, 193: 190-197. DOI: 10.1016/j.thromres.2020.07.007.
[3] Berg CJ, Callaghan WM, Syverson C, et al. Pregnancy-related mortality in the United States, 1998 to 2005[J]. Obstet Gynecol, 2010, 116(6): 1302-1309. DOI: 10.1097/AOG.0b013e3181fdfb11.
[4] 陈锰,刘兴会,梁娟. 中国孕产妇死亡率及死亡原因地区差异及对策[J]. 中国实用妇科与产科杂志,2015,31(12):1095-1099. DOI:10.7504/fk2015110107.
[5] Devis P, Knuttinen MG. Deep venous thrombosis in pregnancy: incidence, pathogenesis and endovascular management[J]. Cardiovasc Diagn Ther, 2017, 7(Suppl 3): S309-S319. DOI: 10.21037/cdt.2017.10.08.
[6] Speed V, Roberts LN, Patel JP, et al. Venous thromboembolism and women's health[J]. Br J Haematol, 2018, 183(3):346-363. DOI: 10.1111/bjh.15608.
[7] Elgendy IY, Fogerty A, Blanco-Molina Á, et al. Clinical characteristics and outcomes of women presenting with venous thromboembolism during pregnancy and postpartum period: findings from the RIETE registry[J]. Thromb Haemost, 2020, 120(10):1454-1462. DOI: 10.1055/s-0040-1714211.
[8] Kleinegris MC, Ten Cate-Hoek AJ, Ten Cate H. Coagulation and the vessel wall in thrombosis and atherosclerosis[J]. Pol Arch Med Wewn, 2012, 122(11):557-566. DOI: 10.20452/pamw.1464.
[9] Simcox LE, Ormesher L, Tower C, et al. Thrombophilia and pregnancy complications[J]. Int J Mol Sci, 2015, 16(12): 28418-28428. DOI: 10.3390/ijms161226104.
[10] James AH, Jamison MG, Brancazio LR, et al. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality[J]. Am J Obstet Gynecol, 2006, 194(5): 1311-1315. DOI: 10.1016/j.ajog.2005.11.008.
[11] Galambosi PJ, Gissler M, Kaaja RJ, et al. Incidence and risk factors of venous thromboembolism during postpartum period: a population-based cohort-study[J]. Acta Obstet Gynecol Scand, 2017, 96(7): 852-861. DOI: 10.1111/aogs.13137.
[12] Mor YS, Schenker JG. Ovarian hyperstimulation syndrome and thrombotic events[J]. Am J Reprod Immunol, 2014, 72(6):541-548. DOI: 10.1111/aji.12310.
[13] Ho J, Sibbald WJ, Chin-Yee IH. Effects of storage on efficacy of red cell transfusion: when is it not safe? [J]. Crit Care Med, 2003, 31(12 Suppl): S687-S697. DOI: 10.1097/01.CCM.0000099349.17094.A3.
[14] Macey MG, Bevan S, Alam S, et al. Platelet activation and endogenous thrombin potential in pre-eclampsia[J]. Thromb Res, 2010, 125(3): e76-e81. DOI: 10.1016/j.thromres.2009.09.013.
[15] Middeldorp S, Ganzevoort W. How I treat venous thromboembolism in pregnancy[J]. Blood, 2020, 136(19): 2133-2142. DOI: 10.1182/blood.2019000963.
[16] Liang ZW, Gao WL, Feng LM. Clinical characteristics and prognosis of cerebral venous thrombosis in Chinese women during pregnancy and puerperium[J]. Sci Rep, 2017, 7: 43866. DOI: 10.1038/srep43866.
[17] Ferro JM, Canhão P, Stam J, et al. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) [J]. Stroke, 2004, 35(3): 664-670. DOI: 10.1161/01.STR.0000117571.76197.26.
[18] Lanska DJ, Kryscio RJ. Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis[J]. Stroke, 2000, 31(6): 1274-1282. DOI: 10.1161/01.str.31.6.1274.
[19] 王静,蔺莉. 妊娠期及产褥期肺血栓栓塞症的早期识别与防治策略[J]. 实用妇产科杂志,2022,38(5):329-333.
[20] Pacheco LD, Saade G, Hankins GD, et al. Amniotic fluid embolism: diagnosis and management[J]. Am J Obstet Gynecol, 2016, 215(2): B16-B24. DOI: 10.1016/j.ajog. 2016.03.012.
[21] Rottenstreich A, Da'as N, Kleinstern G, et al. Pregnancy and non-pregnancy related ovarian vein thrombosis: clinical course and outcome[J]. Thromb Res, 2016, 146: 84-88. DOI: 10.1016/j.thromres.2016.09.001.
[22] Labropoulos N, Malgor RD, Comito M, et al. The natural history and treatment outcomes of symptomatic ovarian vein thrombosis[J]. J Vasc Surg Venous Lymphat Disord, 2015, 3(1): 42-47. DOI: 10.1016/j.jvsv.2014.07.008.
[23] Bukhari S, Fatima S, Barakat AF, et al. Venous thromboembolism during pregnancy and postpartum period[J]. Eur J Intern Med, 2022, 97: 8-17. DOI: 10.1016/j.ejim.2021.12.013.
[24] van der Pol LM, Tromeur C, Bistervels IM, et al. Pregnancy-adapted YEARS algorithm for diagnosis of suspected pulmonary embolism[J]. N Engl J Med, 2019, 380(12): 1139-1149. DOI: 10.1056/NEJMoa1813865.
[25] Abdul Sultan A, Tata LJ, Grainge MJ, et al. The incidence of first venous thromboembolism in and around pregnancy using linked primary and secondary care data: a population based cohort study from England and comparative meta-analysis[J]. PLoS One, 2013, 8(7): e70310. DOI: 10.1371/journal.pone.0070310.
[26] 郭瑞君,巩丽焕. 影像学检查在妊娠期静脉血栓栓塞症诊断中的应用[J]. 中国实用妇科与产科杂志,2018,34(7):725-729. DOI: 10.19538/j.fk2018070106.
[27] Rizzo L, Crasto SG, Rudà R, et al. Cerebral venous thrombosis: role of CT, MRI and MRA in the emergency setting[J]. Radiol Med, 2010, 115(2): 313-325. DOI: 10.1007/s11547-010-0493-4.
[28] Leach JL, Fortuna RB, Jones BV, et al. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls[J]. Radiographics, 2006, 26 Suppl 1: S19-S41, discussion S42-S43. DOI: 10.1148/rg.26si055174.
[29] Saposnik G, Barinagarrementeria F, Brown RD, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2011, 42(4): 1158-1192. DOI: 10.1161/STR.0b013e31820a8364.
[30] Mookadam F, Jiamsripong P, Goel R, et al. Critical appraisal on the utility of echocardiography in the management of acute pulmonary embolism[J]. Cardiol Rev, 2010, 18(1): 29-37. DOI: 10.1097/CRD.0b013e3181c09443.
[31] van Mens TE, Scheres LJ, de Jong PG, et al. Imaging for the exclusion of pulmonary embolism in pregnancy[J]. Cochrane Database Syst Rev, 2017, 1(1): CD011053. DOI: 10.1002/14651858.CD011053.pub2.
[32] Astani SA, Davis LC, Harkness BA, et al. Detection of pulmonary embolism during pregnancy: comparing radiation doses of CTPA and pulmonary scintigraphy[J]. Nucl Med Commun, 2014, 35(7): 704-711. DOI: 10.1097/MNM.0000000000000114.
[33] Bourjeily G, Paidas M, Khalil H, et al. Pulmonary embolism in pregnancy[J]. Lancet, 2010, 375(9713): 500-512. DOI: 10.1016/S0140-6736(09)60996-X.
[34] Matthews S. Short communication: imaging pulmonary embolism in pregnancy: what is the most appropriate imaging protocol? [J]. Br J Radiol, 2006, 79(941): 441-444. DOI: 10.1259/bjr/15144573.
[35] Palm V, Rengier F, Rajiah P, et al. Acute pulmonary embolism: imaging techniques, findings, endovascular treatment and differential diagnoses[J]. Rofo, 2020, 192(1):38-49. DOI: 10.1055/a-0900-4200.
[36] De Cuyper K, Eyselbergs M, Bernard P, et al. Added value of diffusion weighted MR imaging in the diagnosis of postpartum ovarian vein thrombosis[J]. JBR-BTR, 2014, 97(4): 242-244. DOI: 10.5334/jbr-btr.86.
[37] 韩静,常延河,刘运秋,等.延展期抗凝和标准抗凝治疗特发性静脉血栓栓塞性疾病疗效对比[J].实用医学杂志,2023,39(13):1663-1668. DOI:10.3969/j.issn.1006-5725. 2023.13.012.
[38] Tritschler T, Kraaijpoel N, Le Gal G, et al. Venous thromboembolism: advances in diagnosis and treatment[J]. JAMA, 2018, 320(15):1583-1594. DOI: 10.1001/jama.2018.14346.
[39] Knol HM, Schultinge L, Veeger NJ, et al. The risk of postpartum hemorrhage in women using high dose of low-molecular-weight heparins during pregnancy[J]. Thromb Res, 2012, 130(3): 334-338. DOI: 10.1016/j.thromres.2012.03.007.
[40] Bates SM, Rajasekhar A, Middeldorp S, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy[J]. Blood Adv, 2018, 2(22): 3317-3359. DOI: 10.1182/bloodadvances.2018024802.
[41] Kashkoush AI, Ma H, Agarwal N, et al. Cerebral venous sinus thrombosis in pregnancy and puerperium: a pooled, systematic review[J]. J Clin Neurosci, 2017, 39: 9-15. DOI: 10.1016/j.jocn.2017.02.046.
[42] Trukhacheva E, Scharff M, Gardner M, et al. Massive pulmonary embolism in pregnancy treated with tissue plasminogen activator[J]. Obstet Gynecol, 2005, 106(5 Pt 2): 1156-1158. DOI: 10.1097/01.AOG.0000164059. 72933.9c.
[43] 范一木. «颅内静脉和静脉窦血栓形成诊治的中国专家共识»解读[J]. 中国现代神经疾病杂志,2016,16(12):822-825. DOI: 10.3969/j.issn.1672-6731.2016.12.003.
[44] American College of Obstetricians and Gynecologists Women's Health Care Physicians. ACOG Practice Bulletin No. 138: inherited thrombophilias in pregnancy[J]. Obstet Gynecol, 2013, 122(3): 706-717. DOI: 10.1097/01.AOG.0000433981.36184.4e.
[45] Sachdeva A, Dalton M, Lees T. Graduated compression stockings for prevention of deep vein thrombosis[J]. Cochrane Database Syst Rev, 2018, 11(11): CD001484. DOI: 10.1002/14651858.CD001484.pub4.
[46] Chauleur C, Gris JC, Laporte S, et al. Benefit of risk score-guided prophylaxis in pregnant women at risk of thrombotic events: a controlled before-and-after implementation study[J]. Thromb Haemost, 2018, 118(9): 1564-1571. DOI: 10.1055/s-0038-1668524.
[47] Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report[J]. Chest, 2016, 149(2): 315-352. DOI: 10.1016/j.chest.2015.11.026.
[48] 相媛媛,韩燕华.妇科围手术期并发静脉血栓栓塞症38例分析[J].广州医药,2023,54(4):52-56.DOI:10.3969/j.issn.1000-8535.2023.04.009.
[49] Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J]. Chest, 2012, 141(2 Suppl): e691S-e736S. DOI: 10.1378/chest.11-2300.
[50] Rath W, Tsikouras P, von Tempelhoff GF. Pharmacological thromboprophylaxis during pregnancy and the puerperium: recommendations from current guidelines and their critical comparison[J]. Z Geburtshilfe Neonatol, 2016, 220(3): 95-105. DOI: 10.1055/s-0042-106654.