Women with chronic PVT should be informed, not discouraged, about pregnancy

Maternal and fetal outcomes are favorable for most pregnancies that reach 20 weeks' in women with chronic portal vein thrombosis (PVT), a study shows.

The study is the largest yet to examine the outcomes of pregnancies in women with this rare condition, many of whom receive anticoagulation therapy, and its findings could have important consequences for patients.

"Pregnancy has long been thought to be contraindicated in these patients as little was known on the risks of recurrent thrombosis and bleeding, particularly when anticoagulation is given," say author Aurelie Plessier (Universite Paris-VII, Clichy, France) and colleagues.

The retrospective study included 45 pregnancies of 24 women with stable PVT. In all, 22 of the women had complete obstruction of the main portal vein, and the remaining two had thrombosis of the right portal vein branch. Some women also had mesenteric vein obstruction.

Patients were managed with prophylaxis and treatment for complications of portal hypertension, and given treatment with oral anticoagulation therapy on a case-by-case basis. In total, two-thirds of the women received anticoagulation therapy with low molecular weight heparin during their pregnancy.

The rate of miscarriage before 20 weeks' was 20% and the rate of delivery before 37 weeks' was 38%, both of which are much higher than estimates for the general population.

However, the authors found that 64% of all pregnancies had a favorable outcome, defined as a live birth at 32 or more weeks' gestation, with a healthy infant, and no serious obstetric complications.

Furthermore, in pregnancies that reached 20 weeks', all resulted in a live birth, and 81% were considered to have a favorable outcome.

The authors identified underlying thrombocytosis as a likely risk factor for an unfavorable pregnancy outcome. The mean platelet count around diagnosis was 269,000/µL in patients with an unfavorable outcome compared with 189,000/µL in those with a favorable outcome.

They also examined the risk for bleeding, an important concern when pregnant women are treated with anticoagulants. The team found that the rate of bleeding complications was low and did not differ between those receiving anticoagulation therapy and those who were not.

The authors recommend managing the risk through screening prior to pregnancy, prophylaxis for portal hypertension bleeding, and a short interruption of anticoagulation therapy at delivery.

They conclude: "Pregnancy should not be formally contra-indicated in stable PVT-patients." However, they add: "These patients should be accurately informed of fetal and maternal risk of such pregnancy."

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