Several aspects of the diagnostic and therapeutic management of women with
venous thrombosis are uncertain. In this overview, I will discuss three major areas. First, the contribution of
hormone use to
venous thromboembolism (VTE) will be discussed as prudent prescribing of safe preparations can further reduce the risk of
hormone-related VTE. Uncertainties remain regarding certain low-dose
progestagens and transdermal routing of
hormones and their associated risk of VTE. Second, I will review the diagnosis, treatment, and prevention of pregnancy-related VTE. As direct evidence is largely absent for these individuals, these areas are subject to extrapolation from the non-pregnant population. There is therefore an urgent need for the evaluation of diagnostic strategies that safely exclude the diagnosis of acute
pulmonary embolism in pregnant women without the need for diagnostic imaging, which is currently the gold standard, as no studies have confidently demonstrated the safety of ruling out VTE by clinical probability assessment combined with the use of
D-dimer levels. Although identification of women at increased risk of pregnancy-related VTE is relatively well established, controversy remains for asymptomatic women from thrombophilic families. The optimal duration and intensity of
anticoagulant treatment for, and prophylaxis of, pregnancy-related VTE with
low molecular weight heparin is unknown. Third,
anticoagulant therapy to prevent recurrence in women with unexplained
recurrent miscarriage has shown to have no benefit and should not be prescribed. However, whether antithrombotic
therapy prevents
recurrent miscarriage in thrombophilic women, or in women with severe
pregnancy complications, remains unknown and urgently requires future research.