Discover the symptoms and the best ways to prevent hypercoagulability during pregnancy and postpartum

Venous thromboembolism involves two interconnected conditions: deep vein thrombosis and pulmonary embolism. Clots form in deep veins and can break off, traveling to the lungs, posing a life-threatening risk. The lower extremities are most commonly affected, though pelvic veins may also be involved. Symptoms require immediate action, as a pulmonary embolism can be fatal. In Poland, around 40,000 people die from this condition annually. The causes of thrombosis are complex, potentially including genetic predisposition, lifestyle, or prior medication. A key risk factor is prolonged immobility, such as during bed rest or long journeys. Pregnancy and the postpartum period also increase risk due to hormonal changes and uterine pressure on veins. Women in late pregnancy should be particularly vigilant, as leg swelling is common.

The symptoms are not always definitive. They may suggest the presence of venous thrombosis: swelling. Initially, they are noticeable around the ankles, feet, calves, or the entire leg. A distinctive feature of venous thrombosis is the swelling of only one leg, which differentiates it from typical leg fatigue or lymphatic congestion. Leg pain. The discomfort intensifies with movement and subsides when the leg is immobilized. It is usually accompanied by a sensation of tenderness and pain upon contact. Elevated skin temperature or redness. Skin discoloration on the feet and calves. Increased heart rate. Fever, which results from inflammation near the venous wall. If concerning symptoms arise, immediate medical consultation is essential. However, most individuals attempt self-treatment at home using ointments or massages, which can prove fatal.

If you are experiencing any of the aforementioned symptoms, it is essential to seek medical attention immediately. This may involve consulting an internist or a gynecologist who managed your pregnancy. The primary objective is to confirm your concerns. Generally, a primary care physician cannot order a deep vein ultrasound under the National Health Fund (NFZ) but can assess the likelihood of thrombosis using the Wells Scale. If the risk is high, the doctor should refer the patient for urgent diagnostic testing. In cases where the risk is low or moderate, measuring D-dimer levels is recommended. A positive result indicates the need for further diagnostic testing. If symptoms are concerning and you do not wish to wait, a Doppler ultrasound (deep vein ultrasound) should be performed. This examination will reveal whether blood clots are present in your body. The procedure is painless and involves compressing the veins with a specialized probe to evaluate blood flow. While any physician should be able to refer a patient for an ultrasound, in Poland, only a specialist—specifically a vascular surgeon—can authorize the procedure under NFZ. The most common solution is to undergo the ultrasound privately (costing approximately 100–150 PLN) or to visit a hospital emergency department.

Diagnosed deep vein thrombosis requires appropriate treatment aimed at reducing blood viscosity. For this purpose, unfractionated heparin is administered in continuous intravenous infusion (hospital drip) or low-molecular-weight heparin in subcutaneous injections (available at pharmacies). There are ongoing debates regarding long-term anticoagulation therapy. Opinions are divided on whether the full dose of the drug should be administered throughout the entire period or gradually reduced over time. In reality, it depends on the physician's individual decision. There are medical centers that recommend maintaining the full dose throughout pregnancy, while others reduce it to half or 75% of the dose. The latter approach appears more reasonable. In cases of acute thrombosis, the full dose should be administered twice daily. American guidelines suggest the use of low-molecular-weight heparin practically until the time of delivery, while European guidelines recommend unfractionated heparin. Additionally, 6 hours after delivery, low-molecular-weight heparin is administered following the injection of unfractionated heparin. During the postpartum period, the use of low-molecular-weight heparin and oral anticoagulants from the group of vitamin K antagonists is recommended. New oral anticoagulants are not recommended, as studies on their safety are still ongoing. The administration of low, prophylactic doses of heparin (e.g., 5000 units every 12 hours) does not interfere with breastfeeding, as they do not pass into breast milk. The physician should also prescribe compression stockings with the appropriate compression level. These should be worn before getting out of bed, lifting the leg, and putting them on from the foot upwards to the thigh, and removed at night. Rest with elevated legs and exercises that improve blood flow in the lower extremities are also important.

Medical professionals advise using compression socks, stockings, or tights with graduated pressure to enhance circulation and reduce the risk of blood clot formation. Women with elevated risk or a history of the condition should consider pharmacological anti-thrombotic prophylaxis, such as regular subcutaneous injections of low-molecular-weight heparin. It is important to note that many patients (particularly those at risk) take blood-thinning medications throughout their lives, with oral anticoagulants from the vitamin K antagonist group being used in such cases. Post-surgical patients still hospitalized receive early mobilization in addition to heparin to prevent clots. During long car, bus, or plane journeys, it is recommended to stay hydrated, exercise calf muscles, and take short walks. Wearing doctor-prescribed compression stockings and loose-fitting clothing is advised. Individuals who work in a seated position, such as at a computer, should take hourly breaks, move around, or change posture. Additionally, the risk of thrombosis can be mitigated by maintaining a healthy weight, regular physical activity, and smoking cessation. It is crucial to undergo appropriate diagnostic tests during pregnancy to rule out the risk of blood clots.