妊娠期血栓并发症:基于病例的证据回顾。

IF 5.5 2区 医学 Q1 HEMATOLOGY Journal of Thrombosis and Haemostasis Pub Date : 2024-10-11 DOI:10.1016/j.jtha.2024.09.029
Lauren E Merz, Bibi Bassa, Fionnuala Ní Áinle, Annemarie E Fogerty
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引用次数: 0

摘要

由于雌激素导致凝血系统发生变化、静脉淤血增加以及妊娠子宫对血流的外部限制,妊娠是一种促血栓形成状态。静脉血栓栓塞症(VTE)是妊娠期发病和死亡的主要原因。如何预防、识别和治疗妊娠期和产后血栓,往往是临床决策的难题。在妊娠早期,有关血栓性疾病检测和抗凝治疗以提高复发性流产患者活产几率的指导意见正在不断发展。本综述探讨了支持妊娠期常见血栓并发症妇女血栓护理临床决策的新兴数据。第一个病例概述了妊娠期 VTE 诊断、初始抗凝管理、分娩前后和产后管理以及随后的长期抗凝治疗。第二个病例探讨了复发性流产情况下的遗传性和获得性血栓性疾病检测,以及产科抗磷脂综合征的管理。最后,病例三回顾了孕期和产后的 VTE 风险评估和预防,以及产后血栓预防的持续时间和剂量。通过回顾这些常见的妊娠期血栓并发症临床案例,我们可以看到高质量数据的最新进展、当前的知识缺口以及专家意见的差异。最终,多学科讨论和团队合作仍是实现最佳安全护理的关键。临床医生必须优先考虑合作性、高质量的试验和前瞻性临床管理研究,以更好地了解和确定这一人群的最佳治疗方法。
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Thrombotic complications in pregnancy: a case-based review of the evidence.

Pregnancy is a prothrombotic state due to an estrogen-driven shift in the coagulation system, increased venous stasis, and external restriction of blood flow caused by the gravid uterus. Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in pregnancy. Preventing, recognizing, and treating thrombosis in pregnancy, as well as the postpartum period, often challenges decision making in the clinical setting. In early pregnancy, guidance with respects to thrombophilia testing and anticoagulation in increasing the likelihood of live birth among patients with recurrent miscarriages is evolving. This review explores emerging data that support clinical decision making in thrombosis care in women with common thrombotic complications in pregnancy. The first case outlines VTE diagnosis in pregnancy, initial anticoagulation management, management around delivery and postpartum, and subsequent long-term anticoagulation treatment. The second case examines testing for inherited and acquired thrombophilia in the setting of recurrent miscarriage and the management of obstetric antiphospholipid syndrome. Lastly, the third case reviews VTE risk assessment and prevention in pregnancy and the postpartum period, as well as duration and dose of postpartum thromboprophylaxis. Review of these common clinical scenarios surrounding thrombotic complications in pregnancy demonstrates recent advances in high-quality data, current gaps in knowledge, and variation in expert opinion. Ultimately, multidisciplinary discussion and teamwork remain key to optimal, safe care. Clinicians must prioritize collaborative, high-quality trials and prospective clinical management studies to better understand and define best practice in this population.

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来源期刊
Journal of Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis 医学-外周血管病
CiteScore
24.30
自引率
3.80%
发文量
321
审稿时长
1 months
期刊介绍: The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.
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