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MINERVA CARDIOANGIOLOGICA

A Journal on Heart and Vascular Diseases


Official Journal of the Italian Society of Angiology and Vascular Pathology
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  National Meeting of Angiology XXVIII SIAPAV National Congress
Rome, November 15-18, 2006


Minerva Cardioangiologica 2006 December;54(6):799-801

language: Italian

Trombofilia e gravidanza

Carlizza A.

UOC Angiologia, Azienda Ospedaliera S. Giovanni-Addolorata, Roma


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The risk of venous thromboembolism (VTE) increases up to 5-10-fold during pregnancy and VTE represents the first cause of maternal mortality. The annual incidence of VTE is 0.97 per 1000 women during pregnancy and 7.19 per 1000 in the puerperium. The risk is higher in carriers of inherited thrombophilia. Prophy-laxis of VTE during pregnancy in thrombophilic women is still controversial, whereas there is agreement on the use of LMWH or oral anticoagulants during puerperium. LMWH is suggested during pregnancy in antithrombin-deficient women, compound heterozygotes for prothrombin G20210A and factor V Leiden, and homozygotes for these conditions, with no prior VTE. In heterozygotes for F V Leiden or prothrombin G20210A, with no prior VTE, surveillance is preferred during pregnancy and LMWH or OA during puerperium. For patients with APLAs and no prior VTE or fetal loss, one of the following approaches is suggested: prophylactic LMWH and/or low-dose aspirin, , mini-dose heparin, surveillance (7°ACCP). Patients with APLAs and a history of thrombosis should receive therapeutic-dose LMWH or UH plus low-dose aspirin during pregnancy and long-term OA postpartum.
In women with prior VTE and inherited thrombophilia, prophylactic or intermediate-dose LMWH is recommended during pregnancy, plus post-partum OA.. Intermediate-dose LMWH during pregnancy is suggested in antithrombin-deficient women, compound heterozygotes for prothrombin G20210A and factor V Leiden, and homozygotes for these conditions.

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