The Library

Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period

Tools

Tooher, Rebecca, Gates, Simon, Dowswell, Therese and Davis, Lucy-Jane. (2010) Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period. Cochrane Database of Systematic Reviews (No.5). Article CD001689. ISSN 1469-493X

PDF
WRAP_Gates_prophylaxis.pdf - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Download (622Kb)

Official URL: http://dx.doi.org/10.1002/14651858.CD001689.pub2

Abstract

Some women are at risk of forming blood clots in a deep vein during pregnancy, after a caesarean birth, or during the first few weeks after childbirth. If part of the clot breaks off and lodges in a blood vessel in the lungs, it can be life-threatening. Preventive treatments include blood-thinning drugs to prevent clots, support stockings, and exercise soon after the birth to keep circulation moving. However, some drugs might cause problems such as increased blood loss after the birth. Drugs used include heparin, low molecular weight heparin and aspirin. We included 16 randomised controlled studies in the review but only 13 trials with 1774 women contributed data for the outcomes of interest. We did not find enough evidence from the trials to be sure about the effects of these different preventive treatments.This means there is not enough evidence to show which are the best ways to prevent deep vein thrombosis (DVT) during or following pregnancy, or after a caesarean birth.

Item Type:	Journal Article
Subjects:	R Medicine > RG Gynecology and obstetrics
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Thromboembolism, Mothers -- Mortality, Pregnancy -- Complications, Obstetrical pharmacology
Journal or Publication Title:	Cochrane Database of Systematic Reviews
Publisher:	John Wiley & Sons Ltd.
ISSN:	1469-493X
Date:	2010
Number:	No.5
Page Range:	Article CD001689
Identification Number:	10.1002/14651858.CD001689.pub2
Status:	Peer Reviewed
Access rights to Published version:	Open Access
Funder:	University of Liverpool, National Institute for Health Research (Great Britain) (NIHR)
Grant number:	CPGS02 (NIHR)
References:	Burrows 2001 {published data only} Burrows RF, Gan ET, Gallus AS,Wallace EM, Burrows EA. A randomised, double blind placebo controlled trial of low molecular weight heparin as prophylaxis in preventing venous thromboembolic events after caesarean section: a pilot study. BJOG: an international journal of obstetrics and gynaecology 2001; 108:835–9. Casele 2006 {published data only} Casele H. Thrombosis prophylaxis in pregnancy. www.enh.org (accessed 14 June 2005). Casele H, Haney E, James A, Rosene-Montella K, Carson M. Bone density changes in women receiving thromboprophylaxis in pregnancy [abstract]. American Journal of Obstetrics and Gynecology 2005;193(6 Suppl):S14. Casele H, Haney EI, James A, Rosene-Montella K, Carson M. Bone density changes in women who receive thromboprophylaxis in pregnancy. American Journal of Obstetrics and Gynecology 2006; 195:1109–13. Cornette 2002 {published data only} Cornette J, Jacquemyn Y, Vercauteren M, Buytaert P. A randomised trial to compare the effect of pre- or postoperative nandroparin on blood loss during elective caesarean section. Phlebology 2002;17: 67–9. Ellison 2001 {published data only} Ellison J, Thomson AJ, Conkie JA, McCall F, Walker ID, Greer IA. Thromboprophylaxis following caesarean section. A comparison of the antithrombotic properties of three low molecular weight heparins - dalteparin, enoxaparin and tinzaparin. Thrombosis and Haemostasis 2001;86:1374–8. Ellison J, Thomson AJ, Walker ID, Greer IA. Comparisons of the anti-factor XA activities of three commonly used low molecular weight heparins following caesarean section. Scottish Medical Journal 2000;45(3):94–5. Ellison J, Thomson AJ, Walker ID, Greer IA. Thromboprophylaxis following caesarean section: comparison of the anti-factor Xa activities of dalteparin, enoxaparin and tinzaparin. BJOG: an international journal of obstetrics and gynaecology 2000;107:823. Gates 2004a {published data only} Brocklehurst P, Gates S. Randomised controlled trial (PEACH) and meta-analysis of thromboprophylaxis using low-molecular weight heparin (enoxaparin) after caesarean section. Journal of Obstetrics and Gynaecology 2002;22(2 Suppl):S52. Brocklehurst P, Thromboprophylaxis in Pregnancy Advisory Group. Thromboprophylaxis in pregnancy trials: apple, plum and peach. British Journal of Obstetrics and Gynaecology 1998;105 Suppl 17:53. Gates S, Brocklehurst P, Ayers S, Bowler U. Thromboprophylaxis and pregnancy: two randomized controlled pilot trials that used low molecular weight heparin. American Journal of Obstetrics and Gynecology 2004;191:1296–303. National Perinatal Epidemiology Unit. The PEACH Study. www.npeu.ox.ac.uk/trials/peach.html (accessed 12 January 2001). Gates 2004b {published data only} Brocklehurst P, Thromboprophylaxis in Pregnancy Advisory Group. Thromboprophylaxis in pregnancy trials: apple, plum and peach. British Journal of Obstetrics and Gynaecology 1998;105 Suppl 17:53. Gates S, Brocklehurst P, Ayers S, Bowler U. Thromboprophylaxis and pregnancy: two randomized controlled pilot trials that used low molecular weight heparin. American Journal of Obstetrics and Gynecology 2004;191:1296–303. Gates S, Brocklehurst P, Davis LJ. Antenatal thromboprophylaxis using low molecular weight heparin (enoxaparin) for women at risk of thromboembolic disease: multicentre placebo controlled randomised trial (APPLE) and systematic review. Journal of Obstetrics and Gynaecology 2002;22(2 Suppl):S44. National Perinatal Epidemiology Unit. The APPLE Study. www.npeu.ox.ac.uk/trials/apple.html (accessed 12 January 2001). Gibson 1998 {published data only} Gibson JL, Ekevall K, Walker I, Greer IA. Puerperal thromboprophylaxis: comparison of the anti-Xa activity of enoxaparin and unfractionated heparin. British Journal of Obstetrics and Gynaecology 1998;105:795–7. Harenberg 1993 {published data only} Harenberg J, Schneider D, Heilmann L, Wolf H. Lack of antifactor Xa activity in umbilical cord vein samples after subcutaneous administration of heparin or low molecular mass heparin in pregnant women. Haemostasis 1993;23:314–20. Heilmann 1991 {published data only} Heilman L, Heitz R, Koch FU, Ose C. Perioperative thrombosis prophylaxis at the time of caesarean section: results of a randomised prospective comparative study with 6% hydroxyethyl starch 0.62 and low dose heparin [Die perioperative Thromboseprophylaxe beim Kaiserschnitt: Ergebnisse einer randomisierten prospektiven Vergleichsuntersuchung mit 6% Hydroxyathylstarke 0,62 und Low–dose–Heparin]. Zeitschrift fur Geburtshilfe und Perinatologie 1991;195:10–5. Heilmann 2007 {published data only} Heilmann L, Rath W, Pollow K, Bick RL. The rheological changes after cesarean section: the influence of low molecular weight or unfractionated heparin on the rheological properties of blood. Clinical Hemorheology and Microcirculation 2007;37:211–8. Hill 1988 {published and unpublished data} Hill NCW, Hill JG, Sargent JM, Taylor CG, Bush PV. Effect of low dose heparin on blood loss at caesarean section. BMJ 1988; 296:505–6. Hill NCW, Hill JG, Sargent JM, Taylor CG, Bush PV. The effect of low dose heparin on blood loss at caesarean section. 12th FIGO World Congress of Gynecology and Obstetrics; 1988 October 23- 28; Brazil. 1988. Howell 1983 {published data only} Howell R, Fidler J, Letsky E, de Swiet M. The risks of antenatal subcutaneous heparin prophylaxis: a controlled trial. British Journal of Obstetrics and Gynaecology 1983;90:1124–8. Krauss 1994 {published data only} Krauss T, Rath W, Dittmer U, Kuhn W. Use of LMW heparin (Fragmin) for the prevention of thromboembolism in obstetrics [Thromboembolieprophylaxe mit niedermolekularen Heparin (Fragmin)in der Geburtshilfe]. Zeitschrift fur Geburtshilfe und Perinatologie 1994;198:120–5. Pettila 1999 {published data only} Pettila V, Kaaja R, Leinonen P, Ekblad U, Kataja M, Ikkala E. Thromboprophylaxis with low molecular weight heparin (dalteparin) in pregnancy. Thrombosis Research 1999;96:275–82. Pettila V, Leinonen P, Markkola A, Hiilesmaa V, Kaaja R. Postpartum bone mineral density in women treated for thromboprophylaxis with unfractionated heparin or LMW heparin. Thrombosis and Haemostasis 2002;87(2):182–6. Segal 1975 {published data only} Segal S, Sadovsky E, Weinstein D, Polishuk WZ. Prevention of postpartum venous thrombosis with low doses of heparin. European Journal of Obstetrics & Gynecology and Reproductive Biology 1975;5:273–6. Welti 1981 {published data only} Welti H. Prevention of thromboembolism by physiotherapy with and without low dose heparin in gynecology and obstetrics. Results of a controlled, randomized multicenter study [Prophylaxie thrombo–embolique par physiotherapie avec et sans heparine a faibles doses en gynecologie–obstetrique]. Revue Medicale de la Suisse Romande 1981;101(11):925–34. References to studies excluded from this review Badawy 2008 {published data only} Badawy AM, Khiary M, Sherif LS, HassanM, Ragab A, Abdelall I. Low-molecular weight heparin in patients with recurrent early miscarriages of unknown aetiology. Journal of Obstetrics and Gynaecology 2008;28(3):280–4. Blomback 1998 {published data only} Blomback M, Bremme K, Hellgren M, Lindberg H. A pharmacokinetic study of dalteparin (Fragmin) during late pregnancy. Blood Coagulation and Fibrinolysis 1998;9:343–50. Brenner 2005 {published data only} Brenner B, Bar J, Ellis M, Yarom I, Yohai D, Samueloff A, et al.Effects of enoxaparin on late pregnancy complications and neonatal outcome in women with recurrent pregnancy loss and thrombophilia: results from the live-enox study. Fertility & Sterility 2005;84(3):770–3. Brenner B, for the LIVE-ENOX Investigators. Efficacy and safety of two doses of enoxaparin in pregnant women with thrombophilia and recurrent pregnancy loss. The LIVE-ENOX study [abstract]. Blood 2002;100(11 Pt 1):702a. Brenner B, Hoffman R, Carp H, Dulitsky M, Samueloff A, Yohai D, et al.Enoxaparin treatment improves the gestational outcome of pregnant women with thrombophilia and recurrent pregnancy loss: the LIVE-ENOX study [abstract]. Blood 2003;102(11):16a. Brenner B, Hoffman R, Carp H, Dulitsky M, Samueloff A, Yohal D, et al.Efficacy and safety of two doses of enoxaparin in pregnant women with thrombophilia and recurrent pregnancy loss: the LIVE-ENOX study [abstract]. Journal of Thrombosis and Haemostasis 2003;1(Suppl 1):OC084. Brenner B, Hoffman R, Carp H, Dulitsky M, Younis J, LIVEENOX investigators. Efficacy and safety of two doses of enoxaparin in women with thrombophilia and recurrent pregnancy loss: the LIVE-ENOX study. Journal of Thrombosis and Haemostasis 2005;3: 227–9. Chistolini 2006 {published data only} Chistolini A, Torelli F, Giancotti A, Pignoloni P, Muto B, Cosimo C, et al.Recurrent fetal loss: prospective evaluation of the efficacy of three different thromboprophylaxis regimens: aspirin versus low molecular weight heparin versus low molecular weight heparin plus aspirin [abstract]. Hematology Journal 2006;91(Suppl 1):146. De Vries 2005 {published data only} De Vries JIP. Low molecular weight heparin (Fragmin (R)) in pregnant women with a history of uteroplacental insufficiency and thombophilia, a randomized trial (FRUIT-study). Netherlands Trial Register (http://www.trialregister.nl) (accessed 1 November 2005). Dendrinos 2007 {published data only} Dendrinos S, Kalogirou I, Makrakis E, Theodoridis T, Mahmound EA, Christopoulou-Cokkinou V, et al.Safety and effectiveness of tinzaparin sodium in the management of recurrent pregnancy loss. Clinical and Experimental Obstetrics and Gynecology 2007;34(3): 143–5. Farquharson 2002 {published data only} Farquharson RG, Quenby S, Greaves M. Antiphospholipid syndrome in pregnancy: a randomized, controlled trial of treatment. Obstetrics & Gynecology 2002;100(3):408–13. Kutteh 1996a {published data only} Kutteh WH, Ermel LD. A clinical trial for the treatment of antiphospholipid antibody-associated recurrent pregnancy loss with lower dose heparin and aspirin. American Journal of Reproductive Immunology 1996;35:402–7. Kutteh 1996b {published data only} Kutteh WH. Antiphospholipid antibody-associated recurrent pregnancy loss: treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone. American Journal of Obstetrics and Gynecology 1996;174(5):1584–9. Middeldorp 2005 {published data only} Middeldorp S. Aspirin and/or low molecular weight heparin for women with unexplained recurrent miscarriage and/or intra-uterine fetal death. Netherlands Trial Register (http://www.trialregister.nl) (accessed 1 November 2005). Noble 2005 {published data only} Noble LS, Kutteh WS, Lashey N, Franklin RD, Herrada J. Antiphospholipid antibodies associated with recurrent pregnancy loss: prospective, multicenter, controlled pilot study comparing treatment with low-molecular-weight heparin versus unfractionated heparin. Fertility & Sterility 2005;83(3):684–90. Rai 1997 {published data only} Cohen H. Randomized trial of aspirin versus aspirin and heparin in pregnant women with the antiphospholipid syndrome. Annales de Medicine Interne 1996;147 Suppl 1:44. Rai R, Cohen H, Dave M, Regan L. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). BMJ 1997;314:253–7. Rey 2009 {published data only} Rey E. Dalteparin in prevention of recurrence of severe obstetrical complications in women without thrombophilia. JOGC: Journal of Obstetrics and Gynaecology Canada 2007;29(6 Suppl 1):S46. Rey E, Garneau P, David M, Gauthier R, Leduc L, Michon N, et al.Dalteparin for the prevention of recurrence of placental-mediated complications of pregnancy in women without thrombophilia: a pilot randomized controlled trial. Journal of Thrombosis and Haemostasis 2009;7(1):58–64. Stephenson 2004 {published data only} Stephenson MD, Ballem PJ, Tsang P, Purkiss S, Ensworth S, Houlihan E, et al.Treatment of antiphospholipid antibody syndrome (aps) in pregnancy: a randomized pilot trial comparing low molecular weight heparin to unfractionated heparin. Journal of Obstetrics & Gynaecology Canada: JOGC 2004;26(8):729–34. Thaler 2004 {published data only} Thaler I, Brenner B. Efficacy of enoxaparin for improving pregnancy outcomes and uteroplacental blood flow in women with thrombophilia and recurrent pregnancy loss [abstract]. American Journal of Obstetrics and Gynecology 2004;191(6 Suppl 1):S7. Tulppala 1997 {published data only} Tulppala M, Marttunen M, Soderstrom-Anttila V, Foudila T, Ailus K, Palosuo T, et al.Low-dose aspirin in prevention of miscarriage in women with unexplained or autoimmune related recurrent miscarriage: effect of prostacyclin and thromboxane A2 production. Human Reproduction 1997;12(7):1567–72. References to studies awaiting assessment De Veciana 2001 {published data only} De Veciana M, Trail P, Dattel B, Slotnick RN, Abuhamad A. Dalteparin versus unfractionated heparin for prophylactic anticoagulation during pregnancy [abstract]. American Journal of Obstetrics and Gynecology 2001;185(6):S182. Dittmer 1991 {published data only} Dittmer U, Rath W, Schrader J, Zuchner C, Scheler F, Kuhn W. Prevention of deep vein thrombosis (DVT) in pregnancy, after caesarean section and after gynaecological abdominal surgery. A comparison between low molecular weight heparin (LMW) and standard heparin (UFH) [abstract]. Annals of Haematology 1991;62 Suppl 1:A40. Hamersley 1998 {published data only} Hamersley S, Landy H. Low molecular weight heparin is associated with less peripartum blood loss than unfractionated heparin [abstract]. American Journal of Obstetrics and Gynecology 1998;178 (1 Pt 2):S66. Kamin 2008 {published data only} Kamin G, Rogenhofer N, Pildner v. Steinberg S, Neuhoffer A, Seeger S, Schleussner E. Therapy with dalteparin for habitual abortion - presentation of the ETHiG II-Studie [Therapie mit Dalteparin bei habitueller Abortneigung – Vorstellung der ETHiG II–Studie]. Geburtshilfe und Frauenheilkunde 2008;68:S51. STOP CLOT {published data only} Rodger M. The STOP CLOT pilot study: study of low molecular weight heparin in high risk postpartum women following cesarean section (ongoing trial). ClinicalTrials.gov (http://clinicaltrials.gov/) (accessed 21 March 2006). Rodgers M. Thrombophilia in pregnancy prophylaxis study (TIPPS). Ottawa Health Research Institute (http://www.ohri.ca) (accessed 17 July 2002). TIPPS {published data only} Abou-Nassar K, Kovacs MJ, Kahn SR,Wells P, Doucette S, Ramsay T, et al.The effect of dalteparin on coagulation activation during pregnancy in women with thrombophilia. A randomized trial. Thrombosis and Haemostasis 2007;98(1):163–71. Abou-Nassar K, Rodger M, Kovacs MJ, Doucette S, Tim R, Kahn S, et al.The effect of dalteparin on coagulation activation during pregnancy in women with thrombophilia: a randomised trial. Blood 2006;108(11 Pt 1):262. Rodger MA, Kahn S, Cranney A, Hodson A, Kovacs M, Clement AM, et al.Prophylactic low molecular weight heparin (LMWH) during pregnancy is not associated with a decrease in bone mineral density (BMD) [abstract]. Hypertension in Pregnancy 2006;25 (Suppl 1):8. Rodger MA, Kahn SR, Cranney A, Hodsman A, Kovacs MJ, Clement AM, et al.Long-term dalteparin in pregnancy not associated with a decrease in bone mineral density: substudy of a randomized controlled trial. Journal of Thrombosis and Haemostasis 2007;5:1600–6. Rodger MA, Lazo-Langner A, Kahn S, Kovacs M, Robinson S, Blostein M, et al.Prophylactic low molecular weight heparin (LMWH) during pregnancy is not associated with a decrease in bone mineral density (BMD). The TIPPS (Thrombophilia in Pregnancy Prophylaxis Study) BMD substudy. Blood 2005;106 (11):Abstract No 548. Alfirevic 2002 Alfirevic Z, Roberts D, Martlew V. How strong is the association between maternal thrombophilia and adverse pregnancy outcome? A systematic review. European Journal of Obstetrics, Gynecology, & Reproductive Biology 2002;101(1):6–14. Alikhan 2009 Alikhan R, Cohen AT. Heparin for the prevention of venous thromboembolism in general medical patients (excluding stroke and myocardial infarction). Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD003747.pub2] Andersen 1998 Andersen BS, Steffensen FH, Sorensen HT, Nielsen GL, Olsen J. The cumulative incidence of venous thromboembolism during pregnancy and puerperium - an 11 year Danish population - based study of 63,300 pregnancies. Acta Obstetricia et Gynecologia Scandinavica 1998;77:170–3. Atrash 1990 Atrash HK, Koonin LM, Lawson HW, Franks AL, Smith JC. Maternal morbidity in the United States 1979-1986. Obstetrics & Gynecology 1990;76:1055–60. Barbour 1997 Barbour LA. Current concepts of anticoagulant therapy in pregnancy. Obstetrics and Gynecology Clinics of North America 1997; 24:499–521. Bates 2008 Bates S, Greer I, Pabinger I, Sofaer S, Hirsh J. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy. Chest 2008;133:844S–886S. Brenner 2003 Brenner B. Antithrombotic prophylaxis for women with thrombophilia and pregnancy complications--Yes. Journal of Thrombosis & Haemostasis 2003;1(10):2070–2. Brill-Edwards 2000 Brill-Edwards P, Ginsberg JS, Gent M, Hirsh J, Burrows R, Kearon C et al for The Recurrence of Clot in This Pregnancy Study Group. Safety of withholding heparin in pregnant women with a history of venous thromboembolism. New England Journal of Medicine 2000; 343:1439–44. Conard 1990 Conard J, Horellou MH, van Dreden P, Lecompte T, Samama M. Thrombosis and pregnancy in congenital deficiencies of AT III, Protein C or Protein S: study of 78 women. Thrombosis and Haemostasis 1990;63:319–20. Connolly 2003 Connolly T. Thromboembolism prophylaxis and cesarean section: a survey of general obstetricians. Southern Medical Journal 2003;96 (2):146–8. Dargaud 2005 Dargaud Y, Rugeri L, Ninet J, Negrier C, Trzeciak MC. Management of pregnant women with increased risk of venous thrombosis. International Journal of Gynecology & Obstetrics 2005; 90(3):203–7. De Stefano 2006 De Stefano V, Martinelli I, Rossi E, Battaglioli T, Za T, Mannuccio MP, et al.The risk of recurrent venous thromboembolism in pregnancy and puerperium without antithrombotic prophylaxis. British Journal of Haematology 2006;135(3):386–91. Dept of Health 1998 Department of Health. Why mothers die. Report of the Confidential Enquiries into Maternal Deaths 1994-1996. London: HMSO, 1998. Empson 2005 Empson MB, Lassere M, Craig JC, Scott JR. Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database of Systematic Reviews 2005, Issue 2. [DOI: 10.1002/14651858.CD002859.pub2] Friederich 1996 Friederich P, Sanson B-J, Simioni P, Zanardi S, HuismanMV, Kindt I, et al.Frequency of pregnancy-related venous thromboembolism in anticoagulant factor deficient women: implications for prophylaxis. Annals of Internal Medicine 1996;125:955–60. Gherman 1999 Gherman RB, Goodwin TM, Leung B, Byrne JD, Hethumumi R, Montoro M. Incidence, clinical characteristics and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstetrics & Gynecology 1999;94:730–4. Hall 1980 Hall JG, Pauli RM, Wilson KM. Maternal and fetal sequelae of anticoagulation during pregnancy. American Journal of Medicine 1980;68:122–40. Heit 2005 Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ 3rd. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Annals of Internal Medicine 2005;143(10): 697–706. Higgins 2008 Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www.cochranehandbook. org. Högberg 1994 Högberg U, Innala E, Sandstrom A. Maternal mortality in Sweden, 1980-1988. Obstetrics & Gynecology 1994;84:240–4. Kaandorp 2009 Kaandorp S, Di Nisio M, Goddijn M, Middeldorp S. Aspirin or anticoagulants for treating recurrent miscarriage in women without antiphospholipid syndrome. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/ 14651858.CD004734.pub3] Kakkos 2008 Kakkos SK, Caprini JA, Geroulakos G, Nicolaides AN, Stansby GP, Reddy DJ. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/ 14651858.CD005258.pub2.] Knight 2001 Knight M, Duley L, Henderson-Smart DJ, King JF. Antiplatelet agents for preventing and treating pre-eclampsia. Cochrane Database of Systematic Reviews 2001, Issue 4. [DOI: 10.1002/ 14651858.CD000492.pub2] Larciprete 2007 Larciprete G, Gioia S, Angelucci PA, Brosio F, Barbati G, Angelucci GP, et al.Single inherited thrombophilias and adverse pregnancy outcomes. Journal of Obstetrics and Gynaecology Research 2007;33 (4):423–30. Letsky 1997 Letsky EA. Peripartum prophylaxis of thrombo-embolism. Bailliere’s Clinical Obstetrics and Gynaecology 1997;11:523–43. Lewis 2004 Lewis G. Why mothers die, 2000-2002. The Sixth Report of Confidential Enquiries into Maternal Deaths in the United Kingdom. London: RCOG Press, 2004. Lindhagen 1986 Lindhagen A, Bergqvist A, Bergqvist D, Hallbook T. Late venous function in the leg after deep venous thrombosis occurring in relation to pregnancy. British Journal of Obstetrics and Gynaecology 1986;93:348–52. Lindqvist 1999 Lindqvist P, Dahlback B, Marsal K. Thrombotic risk during pregnancy: a population study. Obstetrics & Gynecology 1999;94: 595–9. Macklon 1996 Macklon NS, Greer IA. Venous thromboembolic disease in obstetrics and gynaecology: the Scottish experience. Scottish Medical Journal 1996;41:83–6. Middeldorp 2003 Middeldorp S. Antithrombotic prophylaxis for women with thrombophilia and pregnancy complications--No. Journal of Thrombosis & Haemostasis 2003;1(10):2073–4. Nelson-Piercy 1997 Nelson-Piercy C. Hazards of heparin: allergy, heparin-induced thrombocytopenia and osteoporosis. Bailliere’s Clinical Obstetrics and Gynaecology 1997;11:489–509. NICE 2004 National Collaborating Centre for Women’s and Children’s Health. Commissioned by NICE. Caesarean section. London: RCOG Press, 2004. Orme 1977 Orme ML, Lewis PJ, de Swiet M, Serlin MJ, Sibeon R, Baty JD, et al.May mothers given warfarin breast-feed their infants?. BMJ 1977;1(6076):1564–5. Paull 1987 Paull J. A prospective study of dextran-induced anaphylactoid reactions in 5745 patients. Anaesthesia and Intensive Care 1987;15: 163–7. PEP Trial 2000 PEP Trial Collaborative Group. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin. Lancet 2000;355:1295–302. Pomp 2008 Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJ, Doggen CJM. Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. Journal of Thrombosis & Haemostasis 2008;6(4):632–7. Ramos 2008 Ramos J, Perrotta C, Badariotti G, Berenstein G. Interventions for preventing venous thromboembolism in adults undergoing knee arthroscopy. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD005259.pub3] RCOG 2009 Royal College of Obstetricians and Gynaecologists. Reducing the risk of thrombosis and embolism during pregnancy and the puerperium. Green-top Guideline No. 37. London: RCOG, November 2009. RevMan 2008 The Cochrane Collaboration. Review Manager (RevMan). 5.0. Copenhagen, The Nordic Cochrane Centre: The Cochrane Collaboration, 2008. Rutherford 1991 Rutherford S, Montoro M, McGehee W, Strong T. Thromboembolic disease associated with pregnancy: an 11 year review. American Journal of Obstetrics and Gynecology 1991;164: 286. Simpson 2001 Simpson EL, Lawrenson RA, Nightingale AL, Farmer RD. Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. BJOG: an international journal of obstetrics and gynaecology 2001; 108(1):56–60. Taylor 2000 Taylor GM, McKenzie CA, Mires GJ. Use of a computerised maternity information system to improve clinical effectiveness: thromboprophylaxis at caesarean section. Postgraduate Medical Journal 2000;76(896):354–6. Testroote 2008 Testroote M, Stigter WAH, de Visser DC, Janzing HMJ. Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD006681.pub2] Walker 2003 Walker MC, Ferguson FE, Allen VM. Heparin for pregnant women with acquired or inherited thrombophilias. Cochrane Database of Systematic Reviews 2003, Issue 2. [DOI: 10.1002/ 14651858.CD003580] Wu 2005 Wu O, Robertson L, Twaddle S, Lowe G, Clark P, Walker I, et al.Screening for thrombophilia in high-risk situations: a metaanalysis and cost-effectiveness analysis. British Journal of Haematology 2005;131(1):80–90.
URI:	http://wrap.warwick.ac.uk/id/eprint/3357