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Akhvlediani K.N.

V.I. Krasnopolsky Moscow Regional Clinical Research Institute of Obstetrics and Gynecology

Mel’nikov A.P.

V.I. Krasnopolsky Moscow Regional Clinical Research Institute of Obstetrics and Gynecology

Logutova L.S.

V.I. Krasnopolsky Moscow Regional Clinical Research Institute of Obstetrics and Gynecology

Mravyan S.R.

V.I. Krasnopolsky Moscow Regional Clinical Research Institute of Obstetrics and Gynecology

Fedoryak V.K.

V.I. Krasnopolsky Moscow Regional Clinical Research Institute of Obstetrics and Gynecology

Prevention of thromboembolic complications in obstetric practice

Authors:

Akhvlediani K.N., Mel’nikov A.P., Logutova L.S., Mravyan S.R., Fedoryak V.K.

More about the authors

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To cite this article:

Akhvlediani KN, Mel’nikov AP, Logutova LS, Mravyan SR, Fedoryak VK. Prevention of thromboembolic complications in obstetric practice. Russian Bulletin of Obstetrician-Gynecologist. 2024;24(3):14‑24. (In Russ.)
https://doi.org/10.17116/rosakush20242403114

References:

  1. Lim W, Le Gal G, Shannon MB, Righini M, Haramati LB, Lang E, Kline JA, Chasteen S, Snyder M, Patel P, Bhatt M, Patel P, Braun C, Begum, Wiercioch W, Schünemann HJ, Mustafa RA. American Society of Hem H atology 2018 Guidelines for management of venous thromboembolism: Diagnosis of venous thromboembolism. Blood Adv. 2018;2:22:3226-3256. https://doi.org/10.1182/bloodadvances.2018024828
  2. Leung AN, Bull TM, Jaeschke R, Lockwood CJ. American Thoracic Society Documents: An Official American Thoracic Society/Society of Thoracic Radiology Clinical Practice Guideline. Evaluation of suspected pulmonary embolism in pregnancy. Radiology. 2012;262:2:635-646.  https://doi.org/10.1148/RADIOL.11114045
  3. Heit JA, Spencer FA, White RH. The Epidemiology of venous thromboembolism. J Thromb Thrombolysis. 2016;41:1:3-14.  https://doi.org/10.1007/s11239-015-1311-6
  4. Righini M, Robert-Ebadi H, Elias A, Sanchez O, Le Moigne E, Schmidt J, Le Gall C, Cornuz J, Aujesky D, Roy P-M, Chauleur C, Rutschmann OT, Poletti P-A, Le Gal G; CT-PE-Pregnancy Group. Diagnosis of pulmonary embolism during pregnancy: A Multicenter prospective management outcome study. Ann Intern Med. 2018;169:11:766-773.  https://doi.org/10.7326/M18-1670
  5. Virkus RA, Løkkegaard E, Lidegaard Ø, Langhoff-Roos J, Nielsen AK, Rothman KJ, Berghold T. Risk factors for venous thromboembolism in 1.3 million pregnancies: A nationwide prospective cohort. PloS One. 2014;2;9:5:e96495. https://doi.org/10.1371/JOURNAL.PONE.0096495
  6. Elgendy IY, Gad MM, Mansoor H. Mahmoud AN, Elbadawi A, Saad A, Saad M, Elkaryoni A, Secemsky EA, Mamas MA, Monreal M, Weinberg I, Pepine CJ. Acute pulmonary embolism during pregnancy and puerperium: National trends and in-hospital outcomes. Mayo clinic proceedings. 2021;96:8:2102-2113. 10.1016/j.mayocp.2021.01.015
  7. Anghel L, Sascău R, Radu R., Stătescu C. From classical laboratory parameters to novel biomarkers for the diagnosis of venous thrombosis. Int J Mol Sci. 2020;21:6:1920. https://doi.org/10.3390/IJMS21061920
  8. Chan W-S, Rey E, Kent NE, Corbett T, David M, Douglas MJ, Gibson PS, Magee L, Rodger M, Smith RE. Venous thromboembolism and antithrombotic therapy in pregnancy. J Obstet Gynaecol Can. 2014;36:6:527-553.  https://doi.org/10.1016/S1701-2163(15)30569-7
  9. Van der Pol L, Tromeur C, Bistervels IM, Ainle N. Pregnancy-adapted years algorithm for diagnosis of suspected pulmonary embolism. MCN The American journal of maternal/Child nursing. N Engl J Med. 2019;380:12:1139-1149. https://doi.org/10.1056/NEJMOA1813865/SUPPL_FILE/NEJMOA1813865_DATA-SHARING.PDF
  10. Goodacre S, Horspool K, NelsonPiercy C, Knight M, Shephard N, Lecky F, Thomas S, B J Hunt J, G Fuller G. The DiPEP Study: An observational study of the diagnostic accuracy of clinical assessment, D-dimer and chest x-Ray for suspected pulmonary embolism in pregnancy and postpartum. BJOG. 2019;126:3:383-392.  https://doi.org/10.1111/1471-0528.15286
  11. Konstantinides V, Meyer G, Becattini C, Bueno H, Geersing G, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL; ESC Scientific Document Group. 2019 ESC Guidelines for the siagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS). Eur Heart J. 2020;41:4:543-603.  https://doi.org/10.1093/EURHEARTJ/EHZ405
  12. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: Acute management green-top guideline No 37b 2015.
  13. Leffert L, Butwick A, Carvalho B, Arendt K, Shannon B. The Society for Obstetric Anesthesia and Perinatology consensus statement on the anesthetic management of pregnant and postpartum women receiving thromboprophylaxis or higher dose anticoagulants. Anesthesia Analgesia. 2018;126:3:928-944.  https://doi.org/10.1213/ANE.0000000000002530
  14. Bonow RO, Carabello BA, Kanu C, de Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM, Shah PM, Shanewise JS; 2006 Writing Committee Members; American College of Cardiology/American Heart Association Task Force. 2008 focused update incorporated into the ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: A report of the american college of cardiology/American heart association task force on practice guidelines. Circulation. 2008;118:15:523-661.  https://doi.org/10.1161/CIRCULATIONAHA.108.190748
  15. Shannon MS, Edwards MB, Long F, Taylor KM, Bagger JP, De Swiet M. Anticoagulant management of pregnancy following heart valve replacement in the United Kingdom, 1986—2002. J Heart Valve Dis. 2008;17:5:526-532. 
  16. Walfisch A, Koren G. The «Warfarin Window» in Pregnancy: The importance of half-life. J Obstet Gynaecol Can. 2010;32:10:988-989.  https://doi.org/10.1016/S1701-2163(16)34689-8
  17. Van Hagen IM, Roos-Hesselink JW, Ruys TPE, Merz WM, Goland S, Gabriel H, Lelonek M, Trojnarska O, Al Mahmeed WA, Balint HO, Ashour Z, Baumgartner H, Boersma E, Johnson MR, Hall R; ROPAC Investigators and the EURObservational Research Programme (EORP) Team. Pregnancy in women with a mechanical heart valve: Data of the european society of cardiology registry of pregnancy and cardiac disease (ROPAC). Circulation. 2015;14:132:2:132-142.  https://doi.org/10.1161/CIRCULATIONAHA.115.015242
  18. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W; ESC/EACTS Scientific Document Group. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardio-Thoracic Surg. 2021;60:4:727-800.  https://doi.org/10.1093/EJCTS/EZAB389
  19. Thorp JA, Poskin MF, McKenzie DR, Heimes B. Perinatal factors predicting severe intracranial hemorrhage. Am J Perinatol. 1997;14:10:631-636.  https://doi.org/10.1055/S-2008-1040767
  20. Vanita S, Keepanasseril A, Aggarwal N, Chopra S, Bagga R, Sikka P, Vijayvergiya R. Mechanical valve prosthesis and anticoagulation regimens in pregnancy: A tertiary centre experience. Eur J Obstet, Gynecol, Reprod Biol. 2011;159:2:320-323.  https://doi.org/10.1016/J.EJOGRB.2011.09.011
  21. Scheres Luuk JJ, Lijferring WM, Groenewegen Norbert FM, Koole S, de Groot CJM, Middeldorp S, Cannegieter SC. Hypertensive complications of pregnancy and risk of venous thromboembolism. Hypertension. 2020;75:3:781-787.  https://doi.org/10.1161/HYPERTENSIONAHA.119.14280
  22. Greer IA. Thrombosis in pregnancy: Maternal and fetal issues. Lancet. 1999;353:9160:1258-1265. https://doi.org/10.1016/S0140-6736(98)10265-9
  23. Tripodi A. Hemostasis abnormalities in cirrhosis. Curr Opin Hematol. 2015;22:5:406-412.  https://doi.org/10.1097/MOH.0000000000000164
  24. Villa E, Camma C, Marietta M, Luongo M, Critelli R, Colopi S, Tata C, Zecchini R, Gitto S, Petta S, Lei B, Bernabucci V, Vukotic R, De Maria N, Schepis F, Karampatou A, Caporali C, Simoni L, Del Buono M, Zambotto B, Turola E, Fornaciari G, Schianchi S, Ferrari A, Valla D. Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis. Gastroenterology. 2012;143:5:1253-1260.e4.  https://doi.org/10.1053/J.GASTRO.2012.07.018
  25. Falanga A, Russo L, Verzeroli C. Mechanisms of thrombosis in cancer. Thromb Res. 2013;131:(suppl 1):59-62.  https://doi.org/10.3810/hp.2014.12.1156
  26. Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008;111:10:4902-4907.
  27. Trousseau A. Phlegmasia alba dolens. Clinique Medicale de l’Hotel-Dieu de Paris. 1865;3:654-712. 
  28. Posch F, Thaler J, Zlabinger G-J, Kenigsbregge OT, Koder S, Zielinski C, Pabinger I, Ay C. Soluble vascular endothelial growth factor (SVEGF) and the risk of venous thromboembolism in patients with cancer: Results from the vienna cancer and thrombosis Study (CATS). Clin Cancer Res. 2016;22:1:200-206.  https://doi.org/10.1158/1078-0432.CCR-14-3358
  29. Mauracher LM, Posch F, Martinod K, Grilz E, Däullary T, Hell L, Brostjan C, Zielinski C, Ay C, Wagner DD, Pabinger I, Thaler J. Citrullinated histone H3, a biomarker of neutrophil extracellular trap formation, predicts the risk of venous thromboembolism in cancer patients. J Thrombos Haemostas. 2018;16:3:508-518.  https://doi.org/10.1111/JTH.13951
  30. Neurology. National leadership. Ed. Gusev E.I., Konovalov A.N., Skvortsova V.I. 2nd ed. M.: GEOTAR-Media; 2018. (In Russ.).
  31. Bonfield CM, Engh JA. Pregnancy and brain tumors. 2012;30:3:937-946.  https://doi.org/10.1016/j.ncl.2012.04.003
  32. Kabashneh S, Alkassis S, Shanah L, Alkofahi AA. Venous thromboembolism in patients with brain cancer: Focus on prophylaxis and management. Cureus. 2020;12:6:e877.
  33. Hase EA, Barros VIPVL, Igai AMK, Francisco RPV, Zugaib M. Risk assessment of venous thromboembolism and thromboprophylaxis in pregnant women hospitalized with cancer: Preliminary results from a risk score. Clinics (Sao Paulo). 2018;73:e368.
  34. Streiff MB, Holmstrom B, Angelini D, Ashrani A, Bockenstedt PL, Chesney C, Fanikos J, Fenninger RB, Fogerty AE, Gao S, Goldhaber SZ, Gundabolu K, Hendrie P, Lee AI, Lee JT, Mann J, McMahon B, Millenson MM, Morton C, Ortel TL, Ozair S, Paschal R, Shattil S, Siddiqi T, Smock KJ, Soff G, Wang T-F, Williams E, Zakarija A, Hammond L, Dwyer MA, Engh AM. NCCN Guidelines Insights: Cancer-associated venous thromboembolic disease, version 2.2018. J Natl Compr Canc Netw. 2018;16:11:1289-1303.
  35. Nelson-Piercy C, MacCallum P, Mackillop L. Reducing the risk of venous thromboembolism during pregnancy and the puerperium. Royal green-top guideline No. 37a. College Obstetricians and Gynaecologists. London: RCOG Press; 2015.
  36. Sukhikh GT, Filippov OS, Belokrinitskaya TE, Bitsadze VO, Gur’yanov VA, Dolgushina NV, Kalinina BA, Kan NE, Kiryushchenkov PA, Kirienko AI, Korneeva IE, Levakov SA, Leont’ev SG, Makatsaria AD, Pavlovich SV, Pyregov AV, Runikhina NK, Tyutyunnik VL, Fedorova TA, Khodzhaeva ZS, Shmakov RG, Yavelov IS. Prophylaxis of venous thromboembolic complications in obstetrics and gynecology. Klinicheskie rekomendatsii (protokol). 2014;1-32. (In Russ.).
  37. Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 2012;141:2:691-736. 
  38. Krasnopol’skii VI, Logutova LS, Akhvlediani KN, Travkina AA, Petrukhin VA, Lubnin AYu, Kheireddin AS, Budykina TS, Aksenov AN, Golovin AA, Mel’nikov AP. Cerebrovascular diseases and pregnancy. Akusherstvo i ginekologiya. 2017;8:50-58. (In Russ.).
  39. Liu S, Wee-Shian Ch, Joel GR, Kramer MS. Stroke and cerebrovascular disease in pregnancy. Stroke. 2019;50:1:13-20. 
  40. Terón I, Eng M, Katz JM. Causes and treatment of acute ischemic stroke during pregnancy. Current treatment options in neurology. 2018;20:6:21. 
  41. Elgendy IY, Gad MM, Elgendy A, Mahmoud A, Mahmoud AN, Cuesta J, Rivero F, Alfonso F. Acute pulmonary embolism during pregnancy and puerperium: National trends and in-hospital outcomes. Mayo Clinic proceedings. 2020;96:8:2102-2113.
  42. Watanabe T, Kawaguchi T, Itaya S, Ichijo M, Amino T, Kamata T. Acute ischemic stroke in a 37-year-old pregnant woman successfully treated with recombinant tissue plasminogen activator and endovascular mechanical thrombectomy: A case report. J Neurol Sci. 2017;381:945-1128.
  43. Bhogal P, Aguilar M, AlMatter M, Karck U, Bäzner H, Henkes H. Mechanical thrombectomy in pregnancy: Report of 2 cases and review of the literature. Interv Neurol. 2017;6:1-2:49-56. 
  44. Ladhani NN, Swartz RH, Foley N, Nerenberg K, Smith EE, Gubitz G, Dowlatshahi D, Potts J, Ray JG, Barrett J, Bushnell C, Bal S, Chan WS, Chari R, El Amrani M, Gandhi S, Hill MD, James A, Jeerakathil T, Jin A, Kirton A, Lanthier S, Lausman A, Leffert LR, Mandzia J, Menon B, Pikula A, Poppe A, Saposnik G, Sharma M, Bhogal S, Smitko E, Lindsay MP. Canadian stroke best practice consensus statement: Acute stroke management during pregnancy. Int J Stroke. 2018;13:743-758. 
  45. Pacheco LD, Hankins GDV, Saad AF, Saade GR. Acute management of ischemic stroke during pregnancy. Obstet Gynecol. 2019;133:933-939. 
  46. Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, Hall DR, Warren CE, Adoyi G, Ishaku S; International Society for the Study of Hypertension in Pregnancy (ISSHP). The Hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertension. 2018;13:291-310.  https://doi.org/10.1016/J.PREGHY.2018.05.004
  47. Bousser MG, Crassard I. Cerebral venous thrombosis, pregnancy and oral contraceptives. Thromb Res. 2012;130:19-22. 
  48. Liang ZW, Gao WL, Feng LM Clinical characteristics and prognosis of cerebral venous thrombosis in Chinese women during pregnancy and puerperium. Sci Rep. 2017;7:43866.
  49. Femi OL, Mohammed H, Musa B, Ibrahim D, Gwaram B, Dutse A. Puerperal superior sagittal sinus thrombosis and pulmonary embolism: a case report and review of literature. J Basic Clin Reprod Sci. 2017;3:1:64-67. 
  50. Bates SM, Middeldorp S, Rodger M, James AH, Greer I. Guidance for the treatment and prevention of obstetric-associated venous thromboembolism. J Thromb Thrombolysis. 2016;41:1:92-128. 
  51. Zachary H, Nathan L, Francis C. Cerebral venous sinus thrombosis. JSM Intern Med. 2017;2:1:1003.
  52. Thammishetti V, Dharanipragada S, Basu D, Ananthakrishnan R, Surendiran D. A prospective study of the clinical profile, outcome and evaluation of D-dimer in cerebral venous thrombosis. J Clin Diagn Res. 2016;10:1:7-10.  https://doi.org/10.7860/JCDR/2016/19114.7926
  53. Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell CD, Cucchiara B, Cushman M, deVeber G, Ferro JM, Tsai FY; American Heart Association Stroke Council and the Council on Epidemiology and Prevention. Diagnosis and management of cerebral venous thrombosis: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:1158-1192. https://doi.org/10.1161/STR.0b013e31820a8364
  54. Ferro JM, Canhão P, Stam J, Bousser MG, ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004;35:664-670. 
  55. Ferro JM, Bousser MG, Canhao PO, Coutinho JM, Crassard I, Dentali F, Minno M di, Maino A, Martinell I, Masuhr F, Aguiar de Sousa D, Stam. J. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis — endorsed by the European Academy of Neurology. Eur J Neurol. 2017;10:1-11. 
  56. Yamamoto J, Kakeda S, Takehashi M, Idei M, Nakano Y, Soejima Y, Saito T, Akiba D, Shibata E, Korogi Y, Nishizawa S. Severe subarachnoid hemorrhage associated with cerebral venous thrombosis in early pregnancy: A case report. J Emergency Med. 2013;45:6:849-855.  https://doi.org/10.1016/J.JEMERMED.2013.05.063
  57. Munira Y, Sakinah Z, Zunaina E. Cerebral venous sinus thrombosis presenting with diplopia in pregnancy: A case report. J Med Case Reports. 2012;6:336.  https://doi.org/10.1186/1752-1947-6-336
  58. McCaulley JA, Pates JA. Postpartum cerebral venous thrombosis. Obstet Gynecol. 2011;118: Pt 2:423-425.  https://doi.org/10.1097/AOG.0B013E318212FCA2
  59. Bushnell C, McCullough LD, Awad IA,, Chireau MV, Fedder WN, Furie KL, Howard VJ, Lichtman JH, Lisabeth LD, Piña IL, Reeves MJ, Rexrode KM, Saposnik G, Singh V, Towfighi A, Vaccarino V, Walters MR; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council for High Blood Pressure Research. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:5:1545-1588. https://doi.org/10.1161/01.str.0000442009.06663.48
  60. Liu S, Wee-Shian Ch, Joel GR, Kramer MS. Stroke and cerebrovascular disease in pregnancy. Stroke. 2019;50:1:13-20. 
  61. Swartz RH, Cayley ML, Foley N. The incidence of pregnancy-related stroke: a systematic review and meta-analysis. Int J Stroke. 2017;12:687-697. 
  62. Meeks JR, Bambhroliya AB, Alex KM, Sheth SA, Savitz SI, Miller EC, McCullough LD, Vahidy FS. Association of primary intracerebral hemorrhage with pregnancy and the postpartum period. JAMA Netw Open. 2020;3:4:202769. https://doi.org/10.1001/jamanetworkopen.2020.2769
  63. Ji R, Li G, Zhang R, Hou H, Zhao X, Wang Y. Higher risk of deep vein thrombosis after hemorrhagic stroke than after acute ischemic stroke. J Vasc Nurs. 2019;37:1:18-27. 
  64. Skaf E, Stein PD, Beemath A, Sanchez J, Bustamante MA, Olson RE. Venous thromboembolism in patients with ischemic and hemorrhagic stroke. Am J Cardiol. 2005;96:12:1731-1733.
  65. Paciaroni M, Agnelli G, Venti M, Alberti A, Acciarresi M, Caso V. Efficacy and safety of anticoagulants in the prevention of venous thromboembolism in patients with acute cerebral hemorrhage: a meta-analysis of controlled studies. J Thromb Haemost. 2011;9:5:893-898. 
  66. Guidelines for the management of spontaneous intracerebral hemorrhage: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010;41:9:2108-2129.
  67. Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:7:2032-2060. https://doi.org/10.1161/STR.0000000000000069
  68. Steiner T, Salman RA-S, Beer R, Christensen H, Cordonnier C, Csiba L, Forsting M, Harnof S, Klijn CJ, Krieger D, Mendelow AD, Molina C, Montaner J, Overgaard K, Petersson J, Roine RO, Schmutzhard E, Schwerdtfeger K, Stapf C, Tatlisumak T, Thomas BM, Toni D, Unterberg A, Wagner M; European Stroke Organisation. European stroke organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke. 2014;9:7:840-855.  https://doi.org/10.1111/ijs.12309
  69. Eichinger S, Heinze G, Jandeck LM, Kyrle PA. Risk assessment of recurrence in patients with unprovoked deep vein thrombosis or pulmonary embolism: the Vienna prediction model/Circulation Am Heart Assos. 2010;121:14:1630-1636.
  70. Sultan AA, Tata LJ, West J, Fiaschi L Nelson-Piercy C, Grainge MJ. Risk factors for first venous thromboembolism around pregnancy: A population-based cohort study from the United Kingdom. Blood. 2013;9:121:19:3953-3961. https://doi.org/10.1182/BLOOD-2012-11-469551
  71. Kline JA, Richardson DM, Than MP, Penaloza A, Roy P-M. Systematic review and meta-analysis of pregnant patients investigated for suspected pulmonary embolism in the emergency department. Acad Emerg Med. 2014;21:9:949-959.  https://doi.org/10.1111/ACEM.12471
  72. Kamel H, Navi BB, Sriram N, Hovsepian DA, Devereux RB, Elkind MSV. Risk of a thrombotic event after the 6-week postpartum period. N Engl J Med. 2014;370:14:1307-1315. https://doi.org/10.1056/NEJMOA1311485
  73. Nicholson M, Chan N, Bhagirath V, Ginsberg J. Prevention of venous thromboembolism in 2020 and Beyond. J Clin Med. 2020;9:8:2467. https://doi.org/10.3390/JCM9082467

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