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Risk factors, diagnosis and management of venous thromboembolic disease in pregnancy

Osasere Edebiri, Fionnuala Ní Áinle
Breathe 2022 18: 220018; DOI: 10.1183/20734735.0018-2022
Osasere Edebiri
1Dept of Haematology, Mater University Hospital, Dublin, Ireland
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  • For correspondence: osasere.edebiri@ucdconnect.ie
Fionnuala Ní Áinle
1Dept of Haematology, Mater University Hospital, Dublin, Ireland
2Dept of Haematology, Rotunda Hospital, Dublin, Ireland
3School of Medicine, University College Dublin, Dublin, Ireland
4Irish Network for VTE Research, Dublin, Ireland
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    FIGURE 1

    Venous thromboembolism (VTE) duration of anticoagulation based on risk. For pregnant women with prior VTE (especially those with an unprovoked or a hormone-provoked VTE), predicted recurrence risk during pregnancy is high enough to warrant both antenatal and postnatal thromboprophylaxis, whereas only postpartum thromboprophylaxis is recommended for women with lower predicted recurrence risks. The optimal low molecular weight heparin (LMWH) dose for women with prior VTE is currently being investigated in the ongoing Highlow study. Reproduced and modified from [14] with permission.

Tables

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  • TABLE 1

    Risk factors for venous thromboembolism (VTE) during pregnancy and the postpartum period

    Maternal characteristicsPregnancy characteristicsDelivery characteristics
    Risk factoraORRisk factoraORRisk factoraOR
    Age >35 years1.3IUGR3.8Pre-term delivery2.42.7
    Parity ≥32.4Pre-eclampsia2.9–3.1Prolonged labourNA
    BMI ≥25 kg·m−21.8–2.4Multiple gestation1.7–4.2Instrumental deliveryNA
    Smoker2.1–3.4Caesarean section1.8–3.6
    Comorbidity1.6–8.7Stillbirth6.4#
    Varicose veins2.4MROP2.2
    Thrombophilia3.2–34.4PPH ≥1000 mL4.1
    Prior VTE24.8Infection4.1–6.1
    Family history of VTENAImmobility7.7–10.8

    Adjusted odds ratio (aOR) values are representative and, for clarity, confidence intervals are not included. BMI: body mass index; IUGR: intrauterine growth restriction; MROP: manual removal of placenta; PPH: postpartum haemorrhage; NA: not available. #: incident rate ratio. Reproduced and modified from [12] with permission.

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    Risk factors, diagnosis and management of venous thromboembolic disease in pregnancy
    Osasere Edebiri, Fionnuala Ní Áinle
    Breathe Jun 2022, 18 (2) 220018; DOI: 10.1183/20734735.0018-2022

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    Risk factors, diagnosis and management of venous thromboembolic disease in pregnancy
    Osasere Edebiri, Fionnuala Ní Áinle
    Breathe Jun 2022, 18 (2) 220018; DOI: 10.1183/20734735.0018-2022
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    • Article
      • Abstract
      • Abstract
      • Background
      • Risk factors
      • Prevention
      • Diagnosis of VTE during pregnancy
      • Treatment/management of VTE in pregnancy
      • Long-term VTE sequelae
      • Evidence limitations and research priorities
      • Conclusions
      • Footnotes
      • References
    • Figures & Data
    • Info & Metrics
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    • Respiratory clinical practice
    • Pulmonary vascular disease
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