Thromboembolism in Pregnancy: A Continuing Conundrum
Authors: Richard V. Lee
Journal: Annals of Internal Medicine (2005)

Editorials15 November 2005Thromboembolism in Pregnancy: A Continuing ConundrumRichard V. Lee, MDRichard V. Lee, MDFrom the State University of New York at Buffalo, Buffalo, NY 14214.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-143-10-200511150-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinicians have known for years that pregnancy places women at increased risk for thromboembolism. In 1878, Angus MacDonald described pulmonary embolism and infarction in postmortem examinations of women dying during pregnancy and the postpartum period (1). He commented on the frequency of embolic events in women with cardiovascular disease who died. Our understanding of the pathophysiology and the natural history of thromboembolic disease in pregnant and postpartum patients has been expanding ever since 1856, when Virchow (2) postulated that hypercoagulability, vessel wall injury, and alterations in blood flow foster thrombus formation.Since the observations of MacDonald and Virchow, the location, ...References1. MacDonald A. The Bearings of Chronic Disease of the Heart upon Pregnancy, Parturition, and Childbed. London: J & A Churchill; 1878:43-61. Google Scholar2. Lowe GD. Virchow's triad revisited: abnormal flow. Pathophysiol Haemost Thromb. 2003;33:455-7. [PMID: 15692260] CrossrefMedlineGoogle Scholar3. Seligsohn U, Lubetsky A. Genetic susceptibility to venous thrombosis. N Engl J Med. 2001;344:1222-31. [PMID: 11309638] CrossrefMedlineGoogle Scholar4. Kyrle PA, Eichinger S. Deep vein thrombosis. Lancet. 2005;365:1163-74. [PMID: 15794972] CrossrefMedlineGoogle Scholar5. Treffers PE, Huidekoper BL, Weenink GH, Kloosterman GJ. Epidemiological observations of thrombo-embolic disease during pregnancy and in the puerperium, in 56, 022 women. Int J Gynaecol Obstet. 1983;21:327-31. [PMID: 6141088] CrossrefMedlineGoogle Scholar6. Lee RV, McComb LE, Mezzadri FC. Pregnant patients, painful legs: the obstetrician's dilemma. Obstet Gynecol Surv. 1990;45:290-8. [PMID: 2186317] CrossrefMedlineGoogle Scholar7. Ginsberg JS, Brill-Edwards P, Burrows RF, Bona R, Prandoni P, Buller HR, et al. Venous thrombosis during pregnancy: leg and trimester of presentation. Thromb Haemost. 1992;67:519-20. [PMID: 1519211] CrossrefMedlineGoogle Scholar8. Ray JG, Chan WS. Deep vein thrombosis during pregnancy and the puerperium: a meta-analysis of the period of risk and the leg of presentation. Obstet Gynecol Surv. 1999;54:265-71. [PMID: 10198931] CrossrefMedlineGoogle Scholar9. Danilenko-Dixon DR, Heit JA, Silverstein MD, Yawn BP, Petterson TM, Lohse CM, et al. Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post partum: a population-based, case–control study. Am J Obstet Gynecol. 2001;184:104-10. [PMID: 11174488] CrossrefMedlineGoogle Scholar10. Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med. 2005;143:697-706. LinkGoogle Scholar11. De Swiet M. Thromboembolic disease. Current Obstet Med. 1993;2:163-82. Google Scholar12. Barbour LA, Pickard J. Controversies in thromboembolic disease during pregnancy: a critical review. Obstet Gynecol. 1995;86:621-33. [PMID: 7675391] CrossrefMedlineGoogle Scholar13. De Swiet M. Maternal mortality, a vindication of obstetric medicine. J Obstet Gynaecol. 2003;23:535-9. [PMID: 12963516] CrossrefMedlineGoogle Scholar14. Lee RV. What maternal mortality statistics tell us: high-risk pregnancy, a consequence of medical progress. J Obstet Gynaecol. 2003;23:532-4. [PMID: 12963515] CrossrefMedlineGoogle Scholar15. Brill-Edwards P, Ginsberg JS, Gent M, Hirsh J, Burrows R, Kearon C, et al. Safety of withholding heparin in pregnant women with a history of venous thromboembolism. Recurrence of Clot in This Pregnancy Study Group. N Engl J Med. 2000;343:1439-44. [PMID: 11078768] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Richard V. Lee, MDAffiliations: From the State University of New York at Buffalo, Buffalo, NY 14214.Disclosures: None disclosed.Corresponding Author: Richard V. Lee, MD, 7664 East Quaker Road, Orchard Park, NY 14127; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTrends in the Incidence of Venous Thromboembolism during Pregnancy or Postpartum: A 30-Year Population-Based Study John A. Heit , Catie E. Kobbervig , Andra H. James , Tanya M. Petterson , Kent R. Bailey , and L. Joseph Melton III Metrics Cited byThe "Pregnancy Health-care Program" for the prevention of venous thromboembolism in pregnancyRisk of first venous thromboembolism in and around pregnancy: a population-based cohort studyVenous thromboembolism in womenChronic Medical Conditions in PregnancyTailoring systematic reviews to meet critical priorities in maternal health in the intrapartum periodManaging cardiac disease in pregnancy 15 November 2005Volume 143, Issue 10Page: 749-750KeywordsClinical trialsEpidemiologyMedical risk factorsPregnancyProphylaxisPulmonary embolismThromboembolismThrombosisVeinsVenous thromboembolism ePublished: 15 November 2005 Issue Published: 15 November 2005 Copyright & PermissionsCopyright © 2005 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...