The choice of therapy for DVT of the lower extremity during pregnancy has been widely debated. Warfarin passes through the placenta to the fetus and may cause fetal complications and/or death. Heparin, in contrast, does not cross the placenta, but its long-term use may be impractical and may increase the risk of bleeding, osteoporosis, and neurological complications.
AbuRahma et al.29 analyzed 18 pregnant patients who had Greenfield filters inserted for DVT of the lower extremity and/or PE. The DVT diagnosis was made using duplex imaging. Conventional full-dose intravenous heparin was initiated until the filter was inserted, followed by subcutaneous heparin until labor, and continued for six weeks post-partum in 13 patients who were breast-feeding. Warfarin was given postpartum in the other five patients. The mean age of these pregnant patients was 25 years. The indications for Greenfield insertion included three patients with PE while on anticoagulation, two with significant bleeding secondary to anticoagulation, four for free-floating iliofemoral DVT, two for heparin-induced thrombocytopenia, and seven with iliofemoropopliteal DVT occurring one to three weeks prior to labor, for prophylactic reasons. Fourteen of 18 cases were diagnosed in the third trimester. Filters were inserted via the right internal jugular vein by cutdown in the first four patients (stainless steel filters) and percutaneously in 14 patients. The mean fluoroscopy time during filter insertion was less than two minutes. There was no fetal or maternal morbidity or mortality. In long-term follow-up (mean: 78 months), no PE- or filter-related complications were encountered.
They concluded that Greenfield filter insertion in pregnant patients with DVT of the lower extremity is safe and effective, and its prophylactic use in pregnant patients who develop extensive iliofemoral DVT close to labor may be justified.
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