Pregnancy after cerebral venous thrombosis

Pregnancy outcome in women with previous cerebral vein thrombosis (CVT) on antithrombotic prophylaxis with low-molecular weight heparin (LMWH) is largely unknown. Aims of this study were to evaluate the risk of recurrent VTE, bleeding and pregnancy outcome in a cohort of pregnant women on LMWH after a first episode of CVT. To estimate the efficacy of LMWH in the prevention of obstetrical complications we compared pregnancies before (without LMWH) with pregnancies after (with LMWH) CVT in 25 women. Two recurrent thrombosis (3.2%, 95% CI 0.9-10.9%) and no bleeding episodes were observed in 63 pregnant women on LMWH. The risk of miscarriage was 13.5% (95% CI 6.1-24.8%) and that of late obstetrical complications 19.2% (95% CI 10.2-31.6%), independently of previous history of obstetrical complications and carriership of thrombophilia abnormalities. A double prevalence of terminations was observed in patients with thrombophilia than in those without. In conclusion, women with previous CVT on LMWH prophylaxis during pregnancy have a low risk of recurrent thrombosis and bleeding, but an increased risk of obstetrical complications.