Jornal Vascular Brasileiro
Jornal Vascular Brasileiro

Profilaxia de tromboembolismo venoso na gestação

Venous thromboembolism prophylaxis in pregnancy

André Luiz Malavasi Longo de Oliveira, Marcos Arêas Marques

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O tromboembolismo venoso é importante causa de morbidade e mortalidade obstétrica. Durante a gestação, o risco de sua ocorrência aumenta entre cinco e dez vezes quando comparado ao de mulheres não gestantes de mesma idade. Associado a esse fato, a gestante apresenta algumas limitações para o diagnóstico clínico (alta frequência de dor e edema nos membros inferiores), ecográfico (menor sensibilidade e especificidade no diagnóstico de trombose venosa de ilíaca com a evolução da gestação) e laboratorial (o D-dímero apresenta aumento progressivo no decorrer da gravidez). Uma estratificação criteriosa de risco de tromboembolismo venoso de cada mulher antes da gestação pode diminuir a incidência dessa doença, frequente e de difícil diagnóstico na gravidez, e suas complicações.


trombose venosa; profilaxia; gravidez


Venous thromboembolism is a major cause of obstetric morbidity and mortality. During pregnancy, the risk of occurrence increases between five and ten times when compared to women of the same age who are not pregnant. Compounding this is the fact that pregnant women present certain characteristics that make diagnosis more difficult using clinical signs (high frequency of pain and swelling in the lower limbs), echographic examination (lower sensitivity and specificity for diagnosis of iliac vein thrombosis as pregnancy progresses), and laboratory findings (D-dimer levels progressively increase throughout pregnancy). Conducting careful stratification of women’s venous thromboembolism risk before pregnancy could reduce the incidence of this disease, which is frequent and difficult to diagnose during pregnancy, and of its complications.


venous thrombosis; prophylaxis; pregnancy


1. Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323-33. PMid:25103301.

2. Bourjeily G, Paidas M, Khalil H, Rosene-Montella K, Rodger M. Pulmonary embolism in pregnancy. Lancet. 2010;375(9713):500-12. PMid:19889451.

3. Chan WS, Ray JG, Murray S, Coady GE, Coates G, Ginsberg JS. Suspected pulmonary embolism in pregnancy: clinical presentation, results of lung scanning, and subsequent maternal and pediatric outcomes. Arch Intern Med. 2002;162(10):1170-5. PMid:12020189.

4. Shahir K, Goodman LR, Tali A, Thorsen KM, Hellman RS. Pulmonary embolism in pregnancy: CT pulmonary angiography versus perfusion scanning. AJR Am J Roentgenol. 2010;195(3):214-20. PMid:20729418.

5. Ramsay R, Byrd L, Tower C, James J, Prescott M, Thachil J. The problem of pulmonary embolism diagnosis in pregnancy. Br J Haematol. 2015;170(5):727-8. PMid:25752876.

6. Simcox LE, Ormesher L, Tower C, Greer IA. Pulmonary thromboembolism in pregnancy: diagnosis and management. Breathe. 2015;11(4):282-9. PMid:27066121.

7. 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. Ann Intern Med. 2005;143(10):697-706. PMid:16287790.

8. Greer IA. Thrombosis in pregnancy: updates in diagnosis and management. Hematology. 2012;2012:203-7. PMid:23233582.

9. 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):1307-15. PMid:24524551.

10. Ray JG, Chan WS. Deep vein thrombosis during pregnancy and the puerperium: a meta-analysis of the period of risk and the leg of presentation. Obstet Gynecol Surv. 1999;54(4, Supl):265-71. PMid:10198931.

11. Jacobsen AF, Skjeldestad FE, Sandset PM. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium: a register-based case-control study. Am J Obstet Gynecol. 2008;198(2):233.e1-7. PMid:17997389.

12. 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. Ann Intern Med. 2005;143(10):697-706. PMid:16287790.

13. Gherman RB, Goodwin TM, Leung B, Byrne JD, Hethumumi R, Montoro M. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol. 1999;94(5 Pt 1):730-4. PMid:10546719.

14. Lindqvist P, Dahlbäck B, Marŝál K. Thrombotic risk during pregnancy: a population study. Obstet Gynecol. 1999;94(4):595-9. PMid:10511366.

15. 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. 2001;108(1):56-60. PMid:11213005.

16. Anderson FA Jr, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med. 1991;151(5):933-8. PMid:2025141.

17. Sultan AA, West J, Tata LJ, Fleming KM, Nelson-Piercy C, Grainge MJ. Risk of first venous thromboembolism in and around pregnancy: a population-based cohort study. Br J Haematol. 2012;156(3):366-73. PMid:22145820.

18. Virkus RA, Løkkegaard ECL, Bergholt T, Mogensen U, LanghoffRoos J, Lidegaard Ø. Venous thromboembolism in pregnant and puerperal women in Denmark 1995-2005. A national cohort study. Thromb Haemost. 2011;106(2):304-9. PMid:21713323.

19. Liu S, Rouleau J, Joseph KS, et al. Epidemiology of pregnancyassociated venous thromboembolism: a population-based study in Canada. J Obstet Gynaecol Can. 2009;31(7):611-20. PMid:19761634.

20. Brasil. Ministério da Saúde [site na Internet]. Painel de monitoramento da mortalidade materna. Brasília; 2015. [citado 2016 abr 26].

21. Lewis G. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer 2003-2005: the seventh report of confidential enquiries into maternal and child health in the United Kingdom. London: CEMACH; 2007.

22. Centre for Maternal and Child Enquiries – CMACE. Saving mothers’ lives. Reviewing maternal deaths to make motherhood safer: 2006–08. The eighth report on confidential enquiries into maternal deaths in the United Kingdom. BJOG. 2011;118(Supl 1):1-203.

23. Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk JJ. Saving lives, improving mother’s care: lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-12. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2014.

24. Nelson-Piercy C, Maccallum P, Mackillop MA. Reducing the risk of venous thromboembolism during pregnancy and the puerperium: RCOG green-top guideline. 37. ed. London: RCOG; 2015. [citado 2016 abr 27].

25. Won HS, Kim DY, Yang MS, Lee SJ, Shin H, Park JB. Pregnancyinduced hypertension, but not gestational diabetes mellitus, is a risk factor for venous thromboembolism in pregnancy. Korean Circ J. 2011;41(1):23-7. PMid:21359065.

26. Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS. Maternal mortality and severe morbidity associated with lowrisk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176(4):455-60. PMid:17296957.

27. Kane EV, Calderwood C, Dobbie R, Morris C, Roman E, Greer IA. A population-based study of venous thrombosis in pregnancy in Scotland 1980-2005. Eur J Obstet Gynecol Reprod Biol. 2013;169(2):223-9. PMid:23684606.

28. McColl MD, Walker ID, Greer IA. The role of inherited thrombophilia in venous thromboembolism associated with pregnancy. Br J Obstet Gynaecol. 1999;106(8):756-66. PMid:10453824.

29. Gerhardt A, Scharf RE, Zotz RB. Effect of hemostatic risk factors on the individual probability of thrombosis during pregnancy and the puerperium. Thromb Haemost. 2003;90(1):77-85. PMid:12876629.

30. Knight M. Antenatal pulmonary embolism: risk factors, management and outcomes. BJOG. 2008;115(4):453-61. PMid:18201281.

31. James AH, Jamison MG, Brancazio LR, Myers ER. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol. 2006;194(5):1311-5. PMid:16647915.

32. Larsen TB, Sørensen HT, Gislum M, Johnsen SP. Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study. Thromb Res. 2007;120(4):505-9. PMid:17257657.

33. Robinson HE, O’Connell CM, Joseph KS, McLeod NL. Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol. 2005;106(6):1357-64. PMid:16319263.

34. Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23, Supl 1):16. PMid:12814980.

35. National Collaborating Centre for Women’s and Children’s Health. National Institute for Health and Clinical Excellence. Antenatal care: routine care for the healthy pregnant woman. 2. ed. London: RCOG Press; 2008. Clinical Guideline, 2008.

36. Hezelgrave NL, Whitty CJM, Shennan AH, Chappell LC. Advising on travel during pregnancy. BMJ. 2011;342(1):d2506. PMid:21527456.

37. Greer I. Air travel and pregnancy. London: RCOG; 2013. no. 1. [citado 2014 abr 29].

38. Sultan AA, West J, Tata LJ, Fleming KM, Nelson-Piercy C, Grainge MJ. Risk of first venous thromboembolism in pregnant women in hospital: population based cohort study from England. BMJ. 2013;347(15):f6099. PMid:24201164.

39. Bröms G, Granath F, Linder M, Stephansson O, Elmberg M, Kieler H. Complications from inflammatory bowel disease during pregnancy and delivery. Clin Gastroenterol Hepatol. 2012;10(11):1246-52. PMid:22922307.

40. Erekson EA, Brousseau EC, Dick-Biascoechea MA, Ciarleglio MM, Lockwood CJ, Pettker CM. Maternal postoperative complications after non obstetric antenatal surgery. J Matern Fetal Neonatal Med. 2012;25(12):2639-44. PMid:22735069.

41. Blanco-Molina A, Trujillo-Santos J, Criado J, et al. Venous thromboembolism during pregnancy or postpartum: findings from the RIETE Registry. Thromb Haemost. 2007;97(2):186-90. PMid:17264945.

42. Danilenko-Dixon DR, Heit JA, Silverstein MD, et al. Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post-partum: a population-based, case-control study. Am J Obstet Gynecol. 2001;184(2):104-10. PMid:11174488.

43. Chan WS, Rey E, Kent NE, et al. Venous thromboembolism and antithrombotic therapy in pregnancy. J Obstet Gynaecol Can. 2014;36(6):527-53. PMid:24927193.

44. James A. Practice bulletin no. 123: thromboembolism in pregnancy. Obstet Gynecol. 2011;118(3):718-29. PMid:21860313.

45. Royal College of Obstetricians and Gynaecologists – RCOG. Reducing the risk of thrombosis and embolism during pregnancy and the puerperium. London: RCOG; 2015. Green-top Guideline, 37a. [citado 2016 abr 27].

46. Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis. Chest. 2012;141(2, Supl):e691S-736S. PMid:22315276.

47. Lockwood CJ. ACOG Guidelines at a Glance: the mystery of the antibodies still awaits a solution. Ohio: Contemporary OB/GYN; 2013. [citado 2016 abr 27]. http://contemporaryobgyn.modernmedicine. com/contemporary-obgyn/content/tags/acog-practice-bulletins/acog-guidelines-glance-mystery-antibodies-st

48. Tooher R, Gates S, Dowswell T, Davis LJ. Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period. Cochrane Database Syst Rev. 2010;(5):CD001689. PMid:20464719.

49. Tooher R, Gates S, Dowswell T, Davis LJ. Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period. Cochrane Database Syst Rev. 2010;(5):CD001689. PMid:20464719.

50. Jacobsen AF, Skjeldestad FE, Sandset PM. Ante- and postnatal risk factors of venous thrombosis: a hospital-based case-control study. J Thromb Haemost. 2008;6(6):905-12. PMid:18363820.

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