LETTER
Pregnancy-Related Thromboembolism
Jan P. Vandenbroucke, MD, PhD, and
Frits R. Rosendaal, MD
15 July 1997 | Volume 127 Issue 2 | Pages 164-165
TO THE EDITOR:
In his editorial on thrombosis prophylaxis during pregnancy in women with hereditary or acquired thrombophilia, Lee [1] rightly asks whether all women entering reproductive life should be screened for coagulation deficiencies. For factor V Leiden, we have already answered in the negative: If mass screening for factor V Leiden were followed by routine anticoagulation prophylaxis, even a short course (say, 6 weeks) of oral anticoagulation during the puerperium might cause the death of as many young mothers as, or even more than, would have died of pulmonary emboli resulting from their thrombophilic condition [2]. The recommendation that attention be paid to the personal and family history of thrombosis is borne out by the important paper by Friederich and colleagues [3], whose results pertain to women who already have one or more relatives with venous thrombosis and a coagulation defect. Lee mentions that a fear of litigation in the United States might lead to defensive testing for thrombophilia and prescribing of anticoagulation during the entire pregnancy. We hope that this will be counterbalanced by a fear of hemorrhagic side effects (although we, as Europeans, are not sure whether such side effects might also lead to litigation) [4].
Prescribers should not forget that there are different modes of prophylaxis. For example, it might be worthwhile to investigate prophylaxis with elastic stockings during or after pregnancy (alone or in combination with a very low dose of pharmacologic anticoagulation). In a meta-analysis of prophylaxis in patients having hip surgery, elastic stockings proved to be only slightly less effective than pharmacologic anticoagulation and certainly caused no bleeding [5].
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Author and Article Information
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Leiden University Hospital; 2300 RD Leiden, the Netherlands
1. Lee RV. Thromboembolic disease and pregnancy: are all women equal? [Editorial] Ann Intern Med. 1996; 125:1001-2.
2. Vandenbroucke JP, van der Meer FJ, Helmerhorst FM, Rosendaal FR. Factor V Leiden: should we screen oral contraceptive users and pregnant women? Br Med J. 1996; 313:1127-30.
3. Friederich PW, Sanson BJ, Simioni P, Zanardi S, Huisman MV, Kindt I, et al. Frequency of pregnancy-related venous thromboembolism in anticoagulant factor-deficient women: implications for prophylaxis. Ann Intern Med. 1996; 125:955-60.
4. van der Meer FJ, Rosendaal FR, Vandenbroucke JP, Briet E. Bleeding complications in oral anticoagulant therapy: an analysis of risk factors. Arch Intern Med. 1993; 153:1557-62.
5. Imperiale TF, Speroff T. A meta-analysis of methods to prevent venous thromboembolism following total hip replacement. JAMA. 1994; 271:1780-5.
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