PROPHYLAXIS AND TREATMENT OF THROMBOEMBOL ISM DURING PREGNANCY

Pregnancy and especially delivery and the puerperium are associated wi th an increased risk of thromboembolic disease. Intravenous high dose heparin is the therapy of choice for manifest thromboembolic disease i n pregnancy. However, high-dose heparin fails to prevent postthromboti c chronic venous insufficiency in more than one-third of the cases. Lo w-dose heparin may be used for antithrombotic prophylaxis during pregn ancy. However, low-dose heparin may induce a substantial loss of bone density in up to 30% of cases and may be complicated by heparin-associ ated thrombopenia in up to 2%. This review discusses strategies to red uce these considerable risks. Prospective studies suggest that the ris k of recurrence after prior deep vein thrombosis may be somewhat overe stimated. These data suggest new therapeutic options in women with no risk factors other than a personal history of thrombosis. Improved dia gnostic techniques may contribute to a better evaluation of the indivi dual risk by assessing possible underlying problems such as resistance to activated protein C or deficiencies of coagulation inhibitors. Als o, duration of prophylactic anticoagulation may be reduced by targetin g treatment to periods of increased risk such as immobilisation, dehyd ration, surgery, delivery and the puerperium. Recently, evidence has b een provided indicating that the use of low molecular weight heparins may be associated with reduced loss of bone density and a significantl y attenuated risk of heparin-associated thrombopenia.