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Thromboprophylaxis in Pregnant Women with COVID-19: An Unsolved Issue

Author

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  • Valentin Nicolae Varlas

    (Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
    Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 050451 Bucharest, Romania
    These authors contributed equally to this work.)

  • Roxana Georgiana Borș

    (Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
    These authors contributed equally to this work.)

  • Mihaela Plotogea

    (Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 050451 Bucharest, Romania
    Department of Obstetrics and Gynecology, Nicolae Malaxa Clinical Hospital Bucharest, 022441 Bucharest, Romania)

  • Madalina Iordache

    (Doctoral School, “Carol Davila”, University of Medicine and Pharmacy, 4192910 Bucharest, Romania)

  • Claudia Mehedințu

    (Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
    Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 050451 Bucharest, Romania)

  • Monica Mihaela Cîrstoiu

    (Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 050451 Bucharest, Romania
    Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania)

Abstract

SARS-CoV-2 infection in pregnant women is of growing interest due to controversy over the use of antiplatelet and/or anticoagulant drugs during pregnancy and postpartum. Pregnant women are susceptible to develop severe forms of viral infections due to pregnancy-related immune alterations, changes in lung functions, and hypercoagulability. The association of pregnancy with SARS-CoV-2 infection can cause an increased incidence of thrombotic complications, especially in the case of patients with some genetic variants that favor inflammation and thrombosis. Compared to the general population, pregnant women may be at increased risk of thrombotic complications related to COVID-19. The lack of extensive clinical trials on thromboprophylaxis and extrapolating data from non-pregnant patients lead to major discrepancies in treating pregnant women with COVID-19. Currently, a multidisciplinary team should determine the dose and duration of prophylactic anticoagulant therapy for these patients, depending on the disease severity, the course of pregnancy, and the estimated due date. This narrative review aims to evaluate the protective effect of thromboprophylaxis in pregnant women with COVID-19. It is unknown at this time whether antiplatelet or anticoagulant therapy initiated at the beginning of pregnancy for various diseases (preeclampsia, intrauterine growth restriction, thrombophilia) offers a degree of protection. The optimal scheme for thromboprophylaxis in pregnant women with COVID-19 must be carefully established through an individualized decision concerning gestational age and the severity of the infection.

Suggested Citation

  • Valentin Nicolae Varlas & Roxana Georgiana Borș & Mihaela Plotogea & Madalina Iordache & Claudia Mehedințu & Monica Mihaela Cîrstoiu, 2023. "Thromboprophylaxis in Pregnant Women with COVID-19: An Unsolved Issue," IJERPH, MDPI, vol. 20(3), pages 1-19, January.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:3:p:1949-:d:1042649
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    References listed on IDEAS

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    1. Marcin Januszewski & Laura Ziuzia-Januszewska & Alicja A. Jakimiuk & Waldemar Wierzba & Anna Gluszko & Joanna Zytynska-Daniluk & Artur J. Jakimiuk, 2021. "Is the Course of COVID-19 Different during Pregnancy? A Retrospective Comparative Study," IJERPH, MDPI, vol. 18(22), pages 1-15, November.
    2. Marc A Rodger & Marisol T Betancourt & Peter Clark & Pelle G Lindqvist & Donna Dizon-Townson & Joanne Said & Uri Seligsohn & Marc Carrier & Ophira Salomon & Ian A Greer, 2010. "The Association of Factor V Leiden and Prothrombin Gene Mutation and Placenta-Mediated Pregnancy Complications: A Systematic Review and Meta-analysis of Prospective Cohort Studies," PLOS Medicine, Public Library of Science, vol. 7(6), pages 1-12, June.
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