Peripartum Cardiomyopathy and Thrombosis – A Match Made In Hell!

Pregnancy with peripartum cardiomyopathy (PPCM) is associated with a prothrombotic state. The procoagulant system is activated, signaled by the elevated levels of clotting factors. The natural anticoagulation mechanisms are suppressed, along with the fibrinolytic system. Heart failure (HF) is also known to activate platelets favoring thrombus formation. HF with reduced ejection fraction secondary to multi-factorial etiology in PPCM predisposes to intracardiac thrombus formation and embolic complication, jeopardizing maternal and fetal safety. Anticoagulation with heparin for thrombo-prophylaxis and treatment can prevent the formation and extension of the clot. Risk stratification, prompt identification of patients with intracardiac thrombus, and timely initiation of anticoagulation can mitigate the catastrophic thromboembolic episodes.