Venous thromboembolism - the invisible killer of pregnant women!

The following article comes from the Sixth Hospital Pharmacist, author Huo Yan

Pharmacist of the Sixth Hospital .

Focus on chronic diseases and stay healthy with you.

This is the 4107th article of Da Yi Xiao Hu

Venous thromboembolism (VTE) refers to abnormal coagulation of blood in the veins, which blocks the blood vessels and is a venous reflux disorder. It includes deep vein thrombosis and pulmonary thromboembolism. This disease often occurs acutely, and deep vein thrombosis of the lower extremities is the most common. Once the deep vein thrombosis of the lower extremities breaks off, it can travel to the lungs through the circulatory system, thus forming a pulmonary embolism. VTE is one of the main causes of maternal mortality, with an incidence rate of about 1.4%. Many behaviors during pregnancy can easily lead to VTE, but most pregnant women do not know about it. The following pharmacist will take you to understand VTE.

1. Why are pregnant women more likely to suffer from venous thrombosis?

The three elements of VTE formation are blood stasis, vascular damage and hypercoagulable state. Pregnant women have all three of the above elements, so the risk of VTE in pregnant people is 4-5 times that of the general population, and the risk of VTEs in pregnant women within 6 weeks after delivery is 5-6 times higher than that of pregnant women. Usually, during pregnancy and early postpartum period, pregnant women have reduced activities and long bed rest time, which leads to slower blood flow and easily causes thrombosis. During pregnancy, the uterus gradually enlarges, compressing the inferior vena cava and pelvic veins, causing the pressure of the lower extremity veins to continue to increase. In addition, the level of coagulation factors in pregnant women is also higher than that of normal people.

2. What factors are more likely to cause venous thrombosis?

1. History of thromboembolic disease

Women with this history have a 3-4-fold increased risk of VTE recurrence during pregnancy.

2. Thrombophilia

Some pregnant women have a genotype that makes them more susceptible to thrombosis, which also increases the risk of VTE during pregnancy.

3. Cesarean section

Cesarean section combined with postpartum hemorrhage, or patients with comorbidities such as obesity, hypertension/diabetes, are very likely to develop VTE.

4. Others

In addition, factors such as advanced age, long-term immobility, twins, and in vitro fertilization are all likely to lead to the occurrence of VTE.

III. Drug treatment of venous thrombosis

When pregnant women have venous thrombosis, the use of anticoagulants is the main treatment measure. Both the mother and the fetus should be considered during treatment.

1. Heparin compounds

It includes unfractionated heparin and low molecular weight (LMW) heparin, both of which do not cross the placenta or are secreted in breast milk, and are safe to use during pregnancy and lactation. This drug is an injection and needs to be used by injection. LMW heparin is more effective and easier to give than unfractionated heparin, so LMW heparin is the first choice anticoagulant for most pregnant women, but it needs to be replaced with unfractionated heparin in the last few weeks of pregnancy.

2. Warfarin

Warfarin can cross the placenta and pose a potential risk to the fetus, so it is not recommended for anticoagulation during pregnancy. Except in special circumstances (pregnant women with mechanical heart valves), warfarin anticoagulation can be given after weighing the pros and cons. The breastfeeding level of warfarin is a relatively safe level during breastfeeding. Warfarin will not accumulate in breast milk and has no anticoagulant effect on breastfeeding infants. Therefore, warfarin anticoagulation can be used for breastfeeding women. This drug is an oral medication, and patient compliance is good.

3. New oral anticoagulants (XX xaban, dabigatran)

Since the safety of this type of drug for the fetus is unclear and it can be secreted through breast milk, it should be avoided during pregnancy and lactation.

The use of any anticoagulant may cause bleeding. If bleeding is found, do not panic and contact your doctor immediately.

Although blood clots are scary, there is no need to worry. Pregnant women who do not suffer from blood clots should take active preventive measures, such as eating a proper diet and exercising appropriately. For those who are already suffering from the disease, they should listen to the doctor's advice and take active treatment.

Author: The Sixth People's Hospital

Clinical Pharmacy

Huo Yan