Prevention of Venous Thromboembolism in Pregnancy and the Puerperium: A Comparative Review of Guidelines.

IMPORTANCE

Venous thromboembolism (VTE), presenting either as deep vein thrombosis or as pulmonary embolism, is one of the leading causes of maternal morbidity and mortality.

OBJECTIVE

The aim of this study was to review and compare the most recently published international guidelines providing recommendations on the prevention of VTE in pregnancy and the puerperium.

EVIDENCE ACQUISITION: A comparative review of guidelines by the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the American College of Chest Physicians, the European Society of Cardiology, and the American Society of Hematology on VTE was conducted.

RESULTS

There is an overall agreement among the reviewed guidelines regarding the optimal anticoagulation and dosage choice, the management of low-molecular-weight heparin relating to neuraxial blockade, the importance of implementing risk assessment scores in every individual, and certain indications for obstetric thromboprophylaxis. On the other hand, controversy exists regarding management of unfractionated heparin before and after regional anesthesia, cases where calf compression stockings are suitable and indications where thrombophilia screening is required. Moreover, discrepancies exist in relation to management strategies in women with specific inherited thrombophilias. Notably, specific risk assessment scores are presented only by the Royal College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, and the Society of Obstetricians and Gynecologists of Canada.

CONCLUSIONS

As VTE remains a significant factor affecting maternal morbidity and mortality, worldwide, developing consistent international algorithms is of utmost importance to safely guide clinical practice and consequently improve pregnancy outcomes.