Featured Research

from universities, journals, and other organizations

New Blood Clot Guidelines For Pregnant Women

Date:
June 24, 2008
Source:
American College of Chest Physicians
Summary:
New evidence-based guidelines from the American College of Chest Physicians address the prevention and management of thrombosis in key patient populations, including women who are pregnant, children, and pre-surgical patients.

New evidence-based guidelines address the prevention and management of thrombosis in key patient populations and reinforce recommendations related to the routine use of preventive therapies.

Published as a supplement in the June issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), Antithrombotic and Thrombolytic Therapy: ACCP Evidence-Based Clinical Practice Guidelines, Eighth Edition was developed by an international panel of 90 experts and includes more than 700 of the most comprehensive recommendations related to the prevention, treatment, and long-term management of thrombotic disorders. The guidelines include chapters on the challenges in preventing and treating thrombosis in pregnant women and children, and on managing peri- and postoperative patients, while also reinforcing previous guidelines related to the routine use of preventive therapies, including aspirin.

"For years, clinicians have faced challenges in preventing and managing thrombosis in women who are pregnant or patients who require surgery," said guidelines panel chair Jack Hirsh, MD, FCCP, Henderson Research Center, Hamilton, ON, Canada. "The new guidelines address many troublesome issues in antithrombotic therapy and provide clinicians with a variety of options for care in special patient groups." Antithrombotic and thrombolytic therapies are used to prevent and treat thrombosis or blood clotting that arises in arteries, veins, and the heart.

PREGNANT WOMEN

The new ACCP guidelines address challenging issues facing women who are pregnant or wish to become pregnant while undergoing long-term antithrombotic therapy. Pregnant women taking vitamin K antagonists (VKA), such as the anticoagulant warfarin, have an increased risk for birth defects and miscarriage and are, therefore, advised to stop taking VKAs before 6 weeks of fetal gestation. However, some pregnant women with certain types of mechanical heart valves may be continued on VKA therapy because of concerns about the effectiveness of alternative anticoagulants in preventing stroke and valve thrombosis. For other women taking VKAs who become pregnant, the guidelines recommend substituting low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH). The guidelines recommend two options for doing this: (1) continuing VKA but performing frequent pregnancy tests to determine when pregnancy has been achieved, followed by the substituion of LMWH or UFH as therapy; or (2) substituting VKAs with LMWH or UFH prior to conception. Although the second option eliminates the potential for fetal exposure to VKA, it provides additional challenges. LMWH and UFH are more expensive than VKAs and must be administered through a once- or twice-daily injection as opposed to a once daily oral dose of VKAs. In addition, long-term use of LMWH or UFH can be associated with osteoporosis.

"If women substitute heparin prior to pregnancy and have difficulties conceiving, they may find themselves taking the medication for a much longer timeframe than expected," said guideline coauthor Shannon Bates, MD, McMaster University and Henderson Research Centre, Hamilton, Ontario, Canada. "This is not only inconvenient but also increases treatment costs and may be associated with long-term risks for the mother."

CHILDREN

Recommendations related to childhood stroke, one of the top ten causes of death in children, and congenital heart disease have been substantially expanded since the previous guideline. Arterial ischemic stroke (AIS), usually caused by embolism or thrombosis, is difficult to diagnose in children because underlying health conditions are markedly different than those in adult stroke and up to 15% of children with AIS have no apparent risk factors. The guidelines recommend that children with AIS receive initial antithrombotic therapy until underlying causes can be determined, followed by maintenance therapy to prevent long-term recurrence. In addition, the newly expanded guidelines on the prevention and treatment of thrombosis related to congenital heart disease interventions include discussions of ventricular assist devices and prosthetic heart valves.

"Care for children with major cardiac problems has improved dramatically. Many children who previously died now survive, but thrombosis remains a major cause of secondary complications for these children," said Dr. Hirsh. "Effective antithrombotic therapy is critical if these children are to grow up as normal, healthy children."

PATIENTS UNDERGOING SURGERY

For the first time, the guidelines dedicate a full chapter to the perioperative management of patients on long-term antithrombotic therapy who require surgery or other invasive procedures. Most patients must temporarily stop receiving therapy just prior to undergoing surgery, as well as during surgery, in order to minimize surgery-related bleeding. However, stopping antithrombotic therapy can increase the risk of a thromboembolic event. To address this challenge, the guidelines recommend that the risk of a thromboembolic event during interruption of therapy is balanced against the risk for bleeding when antithrombotic therapy is discontinued just prior to surgery. The guidelines also recommend routine use of thromboprophylaxis for patients undergoing major general, gynecologic, or orthopedic surgeries and have been expanded to include bariatric and coronary artery bypass surgery.

GENERAL RECOMMENDATIONS

Overall, ACCP guidelines recommend thromboprophylaxis for most patients who are hospitalized; however, they do not recommend routine use of thromboprophylaxis for patient groups with a very low risk of venous thromboembolism. Low risk groups include patients undergoing laparoscopic surgery, knee arthroscopy, or those who take long airplane flights. For these patients, physicians can make decisions about thromboprophylaxis based on the individual patient's thrombosis risk. The guidelines continue to recommend against the use of aspirin alone as a means to prevent venous thromboembolism in any patient population because more effective methods are available.

The guidelines are endorsed by the American College of Clinical Pharmacy and the American Society of Health-System Pharmacists. For a copy of the new guidelines, please visit http://www.chestjournal.org.


Story Source:

The above story is based on materials provided by American College of Chest Physicians. Note: Materials may be edited for content and length.


Cite This Page:

American College of Chest Physicians. "New Blood Clot Guidelines For Pregnant Women." ScienceDaily. ScienceDaily, 24 June 2008. <www.sciencedaily.com/releases/2008/06/080624110915.htm>.
American College of Chest Physicians. (2008, June 24). New Blood Clot Guidelines For Pregnant Women. ScienceDaily. Retrieved October 21, 2014 from www.sciencedaily.com/releases/2008/06/080624110915.htm
American College of Chest Physicians. "New Blood Clot Guidelines For Pregnant Women." ScienceDaily. www.sciencedaily.com/releases/2008/06/080624110915.htm (accessed October 21, 2014).

Share This



More Health & Medicine News

Tuesday, October 21, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

How Nigeria Beat Its Ebola Outbreak

How Nigeria Beat Its Ebola Outbreak

Newsy (Oct. 20, 2014) The World Health Organization has declared Nigeria free of Ebola. Health experts credit a bit of luck and the government's initial response. Video provided by Newsy
Powered by NewsLook.com
Another Study Suggests Viagra Is Good For The Heart

Another Study Suggests Viagra Is Good For The Heart

Newsy (Oct. 20, 2014) An ingredient in erectile-dysfunction medications such as Viagra could improve heart function. Perhaps not surprising, given Viagra's history. Video provided by Newsy
Powered by NewsLook.com
Ebola Worries End for Dozens on U.S. Watch Lists

Ebola Worries End for Dozens on U.S. Watch Lists

Reuters - US Online Video (Oct. 20, 2014) Forty-three people who had contact with Thomas Eric Duncan, the first person diagnosed with Ebola in the U.S., were cleared overnight of twice-daily monitoring after 21 days of showing no symptoms. Rough Cut (no reporter narration). Video provided by Reuters
Powered by NewsLook.com
CDC Calls for New Ebola Safety Guidelines

CDC Calls for New Ebola Safety Guidelines

AP (Oct. 20, 2014) Centers for Disease Control and Prevention Director Dr. Tom Frieden laid out new guidelines for health care workers when dealing with the deadly Ebola virus including new precautions when taking off personal protective equipment. (Oct. 20) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins