Embarazo y tromboembolismo pulmonar

Embarazo y tromboembolismo pulmonar Dra Susana Vanoni Comisión Neumonología Clínica Revista Argentina de Medicina Respiratoria   Marzo 2004 - Nº 1: 6-11 La trombosis venosa es 5 veces más frecuente en la mujer embarazada que en la no gestante de igual edad. El 75% de las trombosis venosas ocurren durante el embarazo y el 66% de los eventos embólicos durante el postparto. Tradicionalmente se ha considerado al aumento de la estasis venosa el factor predisponente más común, con una mayor incidencia de eventos trombóticos en el tercer trimestre de la gestación (1,2,3). En la actualidad numerosos autores señalan que la frecuencia es similar durante toda la gestación y en el postparto inmediato, debido a las modificaciones que el propio embarazo produce sobre los factores de la coagulación y los sistemas fibrinolíticos. (1,4,5,6,7). http://www.ramr.org.ar/archivos/numero/ano_4_1_oct_2004/embarazo.pdf   Evidencias para el manejo del tromboembolismo venoso en el embarazo Evidence base for the management of venous thromboembolism in pregnancy. Rodger M. Ottawa Hospital, Ottawa Hospital Research Institute, and University of Ottawa, Ottawa, Ontario, Canada. mrodger@ohri.ca Hematology Am Soc Hematol Educ Program. 2010;2010:173-80. Abstract Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of maternal mortality during pregnancy. DVT and PE are commonly suspected due to many mimicking signs and symptoms that are normal in pregnancy. However, validated diagnostic approaches are lacking, and a fear of teratogenic/oncogenic exposure from imaging procedures affects the acceptability of diagnostic approaches used for VTE during pregnancy. DVT and PE treatment in pregnancy is also challenging due to this lack of validated diagnostic approaches, changes in maternal physiology, and the need for intact hemostasis at the time of delivery/epidural analgesia. Prevention requires an optimal balancing of absolute increased bleeding risk from pharmacologic thromboprophylaxis and the absolute benefit of reduced DVT and PE, which, while serious, are relatively uncommon. http://asheducationbook.hematologylibrary.org/cgi/reprint/2010/1/173  ¿Ha habido algún adelanto en la evolución de los embarazos entre las mujeres con hipertensión arterial pulmonar? Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? Bédard E, Dimopoulos K, Gatzoulis MA. Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. Eur Heart J. 2009 Feb;30(3):256-65. Epub 2009 Jan 15. Abstract Pregnancy in women with pulmonary arterial hypertension (PAH) is considered to be associated with prohibitive maternal mortality. During the past decade, new advanced therapies for PAH have emerged and progress in high-risk pregnancy management has been made. We examined whether these changes have improved outcomes in parturients with PAH. A systematic review of all cases of parturients with idiopathic pulmonary hypertension (iPAH), congenital heart disease associated with PAH (CHD-PAH), or PAH of other aetiology (oPH) published in the past decade (1997-2007) was performed. Outcome data from this study were then compared with relevant data published between 1978 and 1996. Forty-eight case reports or case series met the inclusion criteria, totalling 73 parturients with PAH. Seventy-two per cent of patients with iPAH were receiving advanced therapies, compared with 52% of CHD-PAH and 47% of oPH. Although a publication bias cannot be excluded, overall maternal mortality was significantly lower compared with previous era (25 vs. 38%, P = 0.047) and was 17% in iPAH, 28% in CHD-PAH, and 33% in oPH. Seventy-eight per cent of deaths occurred within the first month after delivery. Primigravidae and parturients who received general anaesthesia were at higher risk of death (OR 3.70, 95% CI 1.15-12.5, P = 0.03 and OR 4.37, 95% CI 1.28-16.50, P = 0.02, respectively). Maternal mortality in parturients with PAH remains prohibitively high, despite lower death rates than previous decades. Early advice on pregnancy risks, including contraception, remains paramount. Women with PAH who become pregnant warrant a multidisciplinary approach with consideration of advanced therapies http://eurheartj.oxfordjournals.org/content/30/3/256.full.pdf+html    Evidencias para el manejo del tromboembolismo venoso en el embarazo Evidence Base for the Management of Venous Thromboembolism in Pregnancy Marc Rodger Ottawa Hospital, Ottawa Hospital Research Institute, and University of Ottawa, Ottawa, Ontario, Canada Hematology 2010 (1): 173. Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of maternal mortality during pregnancy. DVT and PE are commonly suspected due to many mimicking signs and symptoms that are normal in pregnancy. However, validated diagnostic approaches are lacking, and a fear of teratogenic/oncogenic exposure from imaging procedures affects the acceptability of diagnostic approaches used for VTE during pregnancy. DVT and PE treatment in pregnancy is also challenging due to this lack of validated diagnostic approaches, changes in maternal physiology, and the need for intact hemostasis at the time of delivery/epidural analgesia. Prevention requires an optimal balancing of absolute increased bleeding risk from pharmacologic thromboprophylaxis and the absolute benefit of reduced DVT and PE, which, while serious, are relatively uncommon. http://asheducationbook.hematologylibrary.org/cgi/reprint/2010/1/173

Atentamente Dr. Benito Cortes-Blanco  Anestesiología y Medicina del Dolor www.anestesia-dolor.org