CHEST Guidelines-VTE,-Thrombophilia,-Antithrombotic-Therapy,-and-Pr

VTE,-Thrombophilia,-Antithrombotic-Therapy,-and-Pr

Pdf Summary

The 9th edition of the guidelines by the American College of Chest Physicians focuses on antithrombotic therapy and the prevention of thrombosis in pregnant women. The guidelines recommend low-molecular-weight heparin (LMWH) over unfractionated heparin (UFH) for preventing and treating venous thromboembolism (VTE) during pregnancy, highlighting safety and efficacy benefits for both mother and fetus. Vitamin K antagonists are advised against due to potential risks of fetal congenital anomalies, particularly in the first trimester and near delivery.<br /><br />For women with mechanical heart valves, the guidelines suggest anticoagulation regimens tailored to individual risks, incorporating LMWH, UFH, and vitamin K antagonists with considerations for maternal and fetal safety. The use of LMWH during pregnancy is supported due to its reduced risk of osteoporosis and minimal platelet complexities compared to UFH.<br /><br />Breastfeeding mothers are recommended to continue the use of anticoagulants such as warfarin and UFH but consider alternatives to drugs like fondaparinux and direct thrombin inhibitors, which lack sufficient safety data.<br /><br />Aspirin is advised for women at risk of preeclampsia, starting from the second trimester, as it is shown to have a relative risk reduction effect, though the baseline risk determines the absolute benefit. However, for women without known thrombophilia and recurrent pregnancy loss, antithrombotic prophylaxis is not recommended due to insufficient evidence of benefit over potential risks.<br /><br />The guidelines emphasize the need for early and reliable screening and management of pregnancy-related and genetic risk factors for VTE. Medical professionals are encouraged to consider patient-specific factors in treatment plans, and further research is called for to optimize prevention and management strategies for thrombosis in pregnancy.<br /><br />Overall, these guidelines are intended to assist clinicians in making informed decisions about anticoagulant use during pregnancy, balancing maternal and fetal safety while addressing individual patient needs and values.

Keywords

antithrombotic therapy

thrombosis prevention

pregnancy

low-molecular-weight heparin

venous thromboembolism

mechanical heart valves

anticoagulation regimens

preeclampsia

screening and management

clinician guidelines