Venous Thromboembolism in Pregnancy: Pathophysiology,Diagnostic Algorithms,and Therapeutic Approaches

Abstract

Venous thromboembolism (VTE), comprising deep venous thrombosis (DVT) and pulmonary embolism (PE), are frequently observed during pregnancy and may cause maternal death. During pregnancy, several physiological and anatomical changes occur that enhance thrombotic risk. In addition, this risk might be significantly increased by several patient-specific risk factors. Therefore, VTE risk assessment in all pregnant women is essential for early identification of those at increased risk so as to obtain a timely diagnosis and plan a correct therapeutic approach. Unfortunately, clinical examinations may be complicated by the overlap between common physiological symptoms of pregnancy and those indicative of VTE. Thus, validated clinical decision tools such as the LEFt (Left lower extremity (L), Edema (E) and, symptom onset during the First Trimester of pregnancy) rule for suspected DVT and the YEARS algorithm for suspected PE have been developed to aid diagnostic assessment. Definitive diagnosis of DVT or PE requires confirmation with appropriate imaging modalities. An early diagnosis is important to facilitate prompt initiation of therapy that has Low Molecular Weight Heparin as the cornerstone of prevention and treatment during pregnancy and the postpartum period. In this narrative review, we consider the major risk factors for VTE during pregnancy, key diagnostic algorithms and updated therapeutic approaches.