Pharmacotherapeutic management of venous thromboembolism during pregnancy and cesarean section

Introduction: Venous thromboembolism (VTE) pharmacological management during pregnancy can be challenging due to concerns for both maternal and fetal safety. Areas covered: We performed a narrative review to evaluate the most updated therapeutic options for pregnancy-related VTE treatment, also assessing peri-partum management in the case of cesarean section. Expert opinion: The correct management of acute VTE in pregnancy starts with an accurate diagnosis followed by anticoagulant therapy, with low-molecular-weight heparin (LMWH) at therapeutic dose being the preferred option. Similar to the non-pregnant population, thrombolytic therapy is reserved to life-threatening pulmonary embolism. Secondary prophylaxis with LMWH at a prophylactic dose during pregnancy is recommended in women with a history of unprovoked or hormone-associated VTE, while postpartum prophylaxis is recommended for all women with a previous VTE. Primary prophylaxis remains more controversial. Peripartum management of women receiving anticoagulants requires collaboration among multiple specialists, especially in cases of unscheduled cesarean section, where both thrombotic and hemorrhagic risks are elevated.