Management of venous thromboembolism in late pregnancy and risk factor analysis
Objective: To summarize the experience in treatment of venous thromboembolism (VTE) in late pregnancy and analyze the related risk factors. Methods: The clinical data of 43 women with VTE during late pregnancy treated from January 2011 to September 2015 were analyzed retrospectively. Of the patients, 35 cases had deep venous thrombosis (DVT), 7 cases had DVT and concomitant pulmonary thromboembolism (PTE), and one case had PTE only. The clinical manifestations and treatment methods of the patients were overviewed, and using women in late pregnancy without VTE during the same period as control, the related risk factors for VTE were analyzed. Results: All patients received anticoagulant therapy, 31 cases of them received lone anticoagulation therapy, and combined with thrombolytic therapy through superficial instep vein in 1 case, catheter-directed thrombolysis (CDT) through posterior tibial vein puncture in 3 cases, inferior vena cava filter (IVCF) implantation under ultrasound guidance in 2 cases, CDT plus IVCF implantation in 3 cases, and CDT plus IVCF implantation and catheter fragmentation of pulmonary embolism in 3 cases. Six infants had a premature delivery. After treatment, the symptoms were significantly improved in all patients. No symptomatic DVT or PTE occurred during follow-up. Family history of thrombosis, smoking, long-term bed rest, sedentariness, primipara were association with autoimmune disorders, and severe ovarian hyperstimulus syndrome were high risk factors for VTE during late pregnancy (all P<0.05). Conclusion: For patients with VTE in late pregnancy, anticoagulation is the basic treatment, and CDT should be performed in some cases with phlegmasia cerulean dolens, and catheter fragmentation of pulmonary embolism and IVCF implantation should be performed as soon as possible after an occurrence of PTE. Aggressive prevention should be considered for those pregnant women with high risk factors.