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Pregnancy-Related Thromboembolism
- Jan P. Vandenbroucke, MD, PhD; and
- Frits R. Rosendaal, MD
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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].
Jan P. Vandenbroucke, MD, PhD
Frits R. Rosendaal, MD
Leiden University Hospital; 2300 RD Leiden, the Netherlands
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
