1/20. Thromboembolism during pregnancy. Risks, challenges, and recommendations.pregnancy is an important risk factor for venous thrombosis, and venous thromboembolism is a leading cause of preventable death in pregnancy. diagnosis of venous thromboembolism is complicated in that the symptoms of dyspnea and lower extremity edema are relatively common complaints of pregnant patients. physicians should maintain an appropriately high index of suspicion and request diagnostic imaging in a timely manner. diagnosis of deep venous thrombosis with Doppler ultrasonography of the lower extremity poses no health risk to the fetus, but other radiographic studies pose a low radiation risk to the fetus. Because anticoagulant therapy poses a greater health risk to mother and fetus than does the radiation required for the diagnosis of pulmonary embolism, clinicians should aggressively pursue objective evidence of venous thromboembolism. Once the diagnosis is made, anticoagulation with intravenous unfractionated heparin or subcutaneous low-molecular-weight heparin should be used prepartum followed by warfarin therapy after delivery.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
2/20. Labor analgesia in a patient with paroxysmal nocturnal hemoglobinuria with thrombocytopenia.BACKGROUND AND OBJECTIVES: Paroxysmal nocturnal hemoglobinuria (PNH) is a form of acquired hemolytic anemia in which a defect of glycophosphatidylinositol anchor proteins in the cell membrane of bone marrow stem cells leads to activation of the complement system and consequent destruction of defective cells. The characteristics of this disease are an increased frequency of thrombotic events, anemia, and thrombocytopenia. methods: We report a case of a pregnant patient with PNH with thrombocytopenia who delivered vaginally after receiving epidural labor analgesia. Prophylaxis of thromboembolism was performed with heparin 1 hour after the removal of the epidural catheter, and repeated at 12-hour intervals. Sensory changes or motor changes and pain were monitored every 10 minutes for 8 hours after delivery. RESULTS: During analgesia, the patient reported complete pain relief. Delivery and the immediate postpartum period were without any untoward events. CONCLUSIONS: Four major factors influenced the anesthetic conduct used for the present patient: (1) the risk of an acute hemolytic crisis, (2) the need to perform prophylaxis for thromboembolism, (3) the need to reduce labor stress, and (4) minimizing the risk of missing an epidural hematoma. We also present a survey of the literature about PNH and discuss the anesthetic conduct in this patient.- - - - - - - - - - ranking = 0.66666666666667keywords = thromboembolism (Clic here for more details about this article) |
3/20. Severe preeclampsia in antithrombin iii deficiency with no history of venous thromboembolism.Complications of pregnancy, such as preeclampsia, placental abruption, fetal growth retardation, still-birth and fetal death are associated with an increased frequency of pro-thrombotic abnormalities. We describe a case of severe preeclampsia and multiple placental infarctions in a 28-year-old woman at 31 weeks' gestation. Despite a negative personal history for venous thromboembolism, coagulation screening for thrombophilia detected an isolated antithrombin iii deficiency. In view of the high prevalence of pro-thrombotic complications, laboratory screening for thrombophilia would be advantageous in women with complicated pregnancies, to ensure adequate management in high-risk situations, as suggested by larger-scale clinical investigations.- - - - - - - - - - ranking = 1.6666666666667keywords = thromboembolism (Clic here for more details about this article) |
4/20. Management of pregnancy with congenital antithrombin iii deficiency: two case reports and a review of the literature.Women with antithrombin (AT) III deficiency are prone to pregnancy-associated venous thromboembolism. We report 2 cases with genetically confirmed ATIII deficiency, one with a mutation in exon 3A and the other with an exon 4 deletion, in whom the pregnancies were successfully managed with prophylactic therapies for thrombosis. A 35-year-old pregnant woman was treated with intravenous infusions of ATIII concentrate alone, and the other 22-year-old pregnant woman was mainly treated with subcutaneous injections of heparin and oral low-dose aspirin therapy. Both pregnancies resulted in vaginal deliveries of healthy neonates. The literature concerning prophylactic therapies for thrombosis in ATIII deficiency-complicated pregnancy is reviewed, and the clinical problems, including the adverse effects of the therapies, are discussed.- - - - - - - - - - ranking = 0.33333333333333keywords = thromboembolism (Clic here for more details about this article) |
5/20. Hemorrhagic complication of anticoagulation during pregnancy in a woman with lupus anticoagulant.BACKGROUND: Lupus anticoagulant is an acquired antiphospholipid antibody that can increase greatly the risk of thromboembolism during pregnancy. Because a baseline elevated activated partial thromboplastin time (PTT) is associated frequently with this antibody, monitoring anticoagulant effect with activated PTT can be unreliable. CASE: A pregnant woman with lupus anticoagulant being treated with adjusted dose heparin experienced concurrent severe thrombotic and hemorrhagic complications. CONCLUSION: This case illustrates the pitfall of activated PTT monitoring when administering anticoagulation therapy to a patient with a baseline elevated activated PTT. We propose that heparin levels be used to monitor anticoagulation in these patients.- - - - - - - - - - ranking = 0.33333333333333keywords = thromboembolism (Clic here for more details about this article) |
6/20. Use of low molecular weight heparin for prophylaxis and treatment of thromboembolism in pregnancy.Low molecular weight heparin (LMWH) preserves the antithrombotic action but not the anticoagulant activity of heparin. LMWH is safe, does not cross the placenta and is administered as a single daily injection. We report our experience with 6 pregnant women given LMWH for treatment or prophylaxis of thromboembolism. The drug was successfully given to 5 women for periods of 6 weeks--6 months and no thromboembolic complications occurred during pregnancy or pueperium. There were no hemorrhagic complications and no excessive bleeding was observed during delivery. The sixth patient relapsed after 6 weeks of therapy. This patient also showed resistance to standard heparin administered intravenously at a very high dose. LMWH should be considered an alternative to standard heparin in pregnant women requiring antithrombotic prophylaxis and therapy.- - - - - - - - - - ranking = 1.6666666666667keywords = thromboembolism (Clic here for more details about this article) |
7/20. venous thromboembolism in pregnancy. A case report of deep venous thrombosis (DVT) in puerperium.The authors describe a case of DVT during pregnancy in a 41-year-old woman who had a normal haemocoagulative picture during pregnancy and in puerperium (PT, PTT, S protein, C protein, ATIII, xdp and fibrinogenous). All the haemocoagulative dosages were within the norm and compatible with the gestation period. Both homocysteine and antiphospholipid antibodies (mostly in puerperium) were always within normal limits. The authors believe that DVT occurs infrequently but it is also unforeseeable. Systematic heparin prophylaxis for seven to ten days, ante- and postpartum, can prevent this problem.- - - - - - - - - - ranking = 1.3333333333333keywords = thromboembolism (Clic here for more details about this article) |
8/20. The pregnant antithrombin III deficient patient: management without antithrombin III concentrate.Pregnant patients with antithrombin III (AT III) deficiency have an unacceptably high risk of venous thromboembolism (VTE). Antithrombotic therapy is therefore recommended. The reported clinical experience of such prophylaxis is limited. Some authors have recommended the use of AT III concentrate in addition to heparin in the management of these patients. We report successful management with heparin alone during pregnancy and the postpartum period in two patients with AT III deficiency. Both patients had experienced VTE during a prior pregnancy; one also experienced VTE during the reported pregnancy. Both patients were therefore at particularly high risk of further VTE. Based on the good results in these two patients, and a review of previously reported cases, we propose that heparin alone, in a dose to maintain the APTT in a therapeutic range, provides adequate prophylaxis and treatment for VTE during pregnancy and delivery in many AT III deficient subjects.- - - - - - - - - - ranking = 0.33333333333333keywords = thromboembolism (Clic here for more details about this article) |
9/20. Protein S and congenital protein s deficiency: the most frequent congenital thrombophilia in Japanese.Protein S is a natural anticoagulant. Congenital protein S (PS) deficiency is a confirmed risk factor of venous thromboembolism (DVT) which though occurs infrequently yet is a leading cause of maternal mortality and morbidity. Congenital PS deficiency may also be responsible for obstetric complications such as preeclampsia/eclampsia, recurrent fetal loss and intrauterine fetal restriction. Congenital PS deficiency has been identified in 1-7.5% of patients with DVT and in 0.03-0.13% general Caucasian population. However, Japanese people have higher prevalence both in VTE patients (12.7%) and general population (0.48-0.63%). Because PS deficiency is the most frequent congenital thrombophilia in Japanese people, Japanese obstetricians must understand this thrombophilia and also that women with PS deficiency have an increased risk of VTE and a necessity of prophylactic use of anticoagulant against recurrent VTE during pregnancy and puerperium. This article reviews the literature to understand PS and congenital PS deficiency, especially the association of this thrombophilia with pregnancy.- - - - - - - - - - ranking = 0.33333333333333keywords = thromboembolism (Clic here for more details about this article) |
10/20. Failure of thromboprophylaxis in pregnancy caused by dual deficiencies of protein S and protein c.Protein S and protein c deficiencies are commonly identified biochemical abnormalities associated with a hypercoagulable state; they result in an increased incidence of venous thromboembolism. We report the case of a pregnant woman with dual deficiencies of protein S and protein c, who encountered a venous thromboembolism 7 days postpartum despite of the use of danaparoid.- - - - - - - - - - ranking = 0.66666666666667keywords = thromboembolism (Clic here for more details about this article) |
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