Venous thromboembolism in pregnancy

The American Journal of Medicine, 2007

Annals of Vascular Surgery, 2011

Background: To evaluate the incidence and characteristics of venous thromboembolic events (VTE) associated with pregnancy in a contemporary patient series. Methods: We performed a retrospective review of 33,311 deliveries between June 2003 and June 2008. Patients with objective documentation of a VTE during pregnancy or the 3-month postnatal period were identified from hospital discharge International Classification of Disease Codes edition 9 codes. Diagnosis of deep venous thrombosis (DVT) was largely made by a Duplex ultrasound, whereas pulmonary embolism (PE) was diagnosed by a computerized tomographic angiography (CTA). Results: Of 33,311 deliveries during the study period, 74 patients (0.22%) had a VTE. There were 40 incidents of DVT (0.12%) and 37 of PE (0.11%). DVT involved the iliac veins (6), the femoral or popliteal veins (16), the infrapopliteal veins (17), and the axillary vein (1). Most (57.5%) of the DVTs involved the left lower extremity. Thirty-eight (51.6%) of the VTEs occurred in the postnatal period, and of those 33 (87%) occurred within 1 week of delivery. Most of the postnatal VTEs (68%) were seen in patients who underwent a cesarean section. Among patients with VTE during pregnancy, there were 28% in the first trimester, 25% in the second, and 47% in the third. Events were distributed among maternal age groups as follows: 26% aged 13-24, 50% aged 25-34, and 24% aged 35-54. Of the 35 patients tested for a hypercoagulable disorder, 12 were found to have a positive test result. Five (6.8%) of these 74 patients had a prior history of VTE, with two having a hypercoagulable disorder. In addition, 45 of the 74 patients were on oral contraceptive therapy or received hormonal stimulation therapy before pregnancy. Patients with a VTE during pregnancy were treated with low molecular weight or unfractionated heparin. Most postnatal patients were treated with subcutaneous low molecular weight heparin and coumadin. Six inferior vena cava filters were placed in patients with bleeding complications as a result of anticoagulation. There were no deaths during the study period. Conclusions: Comparing our results with historic controls (DVT: 0.04-0.14% and PE: 0.003-0.04%), the incidence of DVT in pregnancy has not changed significantly. We note, however, that the incidence of pulmonary embolus in our series is higher than previously reported. CTA has been used for the diagnosis of PE since the past decade. The increase in the rate of PE in the current series may be because of the higher sensitivity of CTA when compared with previous diagnostic modalities.

Thrombosis and Haemostasis, 2007

Ve nous thromboembolism( VTE)o ccurs infrequentlyd uring pregnancy, and issuesconcerning its natural history,prevention and therapyremain unresolved. RIETEisanongoing registryof consecutivep atientsw ith objectivelyc onfirmed, symptomatic acute VTE.Int his analysis, we compared the clinical characteristics and outcome fora ll enrolledp regnanta nd postpartum womenwith acuteVTE,and allnon-pregnant womeninthe same ager ange.Upt oM ay 2005, 11,630 patients were enrolledi n RIETE, of whom8 48 (7.3%) were womena ged< 47 years. Of them, 72 (8.5%)werepregnant, 64 (7.5%)postpartum. Pregnant womenpresented less often with symptomaticpulmonary embolism(11%)than non-pregnant women(39%).VTE developed during the first trimester in 29 (40%) pregnant patients;int he second in 13; in the thirdin30.Thrombophilia testsweremore

Internal Medicine Journal, 2012

Background: North American and European literature suggest that the incidence rate for pregnancy-related thromboembolism (VTE) ranges from 0.5 to 2 per 1000 pregnancies. However, there is a paucity of data regarding pregnancy-related VTE in Australia and New Zealand.

TH open, 2021

Introduction The risk of venous thromboembolism (VTE) increases during pregnancy and the puerperium such that VTE is a leading cause of maternal mortality. Methods We describe the clinical characteristics, diagnostic strategies, treatment patterns, and outcomes of women with pregnancy-associated VTE (PA-VTE) enrolled in the Global Anticoagulant Registry in the FIELD (GARFIELD)-VTE. Women of childbearing age (<45 years) were stratified into those with PA-VTE (n ¼ 183), which included pregnant patients and those within the puerperium, and those with nonpregnancy associated VTE (NPA-VTE; n ¼ 1,187). Patients with PA-VTE were not stratified based upon the stage of pregnancy or puerperium. Results Women with PA-VTE were younger (30.5 vs. 34.8 years), less likely to have pulmonary embolism (PE) (19.7 vs. 32.3%) and more likely to have left-sided deep vein thrombosis (DVT) (73.9 vs. 54.8%) compared with those with NPA-VTE. The most common risk factors in PA-VTE patients were hospitalization (10.4%), previous surgery (10.4%), and family history of VTE (9.3%). DVT was typically diagnosed by compression ultrasonography (98.7%) and PE by chest computed tomography (75.0%). PA-VTE patients more often à A full list of investigators is given in the ►Supplementary Material.

PLoS ONE, 2014

Objective: To quantify risk factors for venous thromboembolism during pregnancy and the puerperal period.

Annals of Internal Medicine, 2006

We congratulate Heit and colleagues (1) on their study on the incidence of venous thromboembolism during pregnancy and the puerperium. However, we take issue with their statement that the venous thromboembolic incidence was 3.6% and 1.5% in the first and second weeks postpartum, respectively, similar to the 2% to 5% incidence of symptomatic venous thromboembolism after elective hip replacement in patients not receiving prophylaxis. This seems unlikely when only 105 maternal cases of venous thromboembolism were diagnosed during pregnancy or postpartum in 50 000 births. This discrepancy relates to the method the authors have used to calculate the incidence. For some purposes, it makes sense to compare incident rates per person-year at risk, as the authors have done. In this instance, in consideration of the possible benefit of thromboembolic prophylaxis, it is more relevant to know the chance of an individual having an event postpartum. It is misleading of the authors to compare the 2 types of measure. The incidence rate per 100 000 person-years in week 1 postpartum is 3573 per 100 000. However, this is not 3.6% of pregnant women who have an event in the first week postpartum. Because by this point women have only been at risk for 1 week out of 52 in a year, only 68 per 100 000 or 0.68 per 1000 will have had an event in that week. In the authors' Table 1, the postpartum risk for venous thromboembolism in women older than age 35 years (the highest-risk group) is reported as approximately 900 per 100 000 person-years. Because the postpartum period defined by the authors is 3 months, the risk to a woman who has delivered is approximately 225 per 100 000 (13 of 52 of the rate per 100 000 person-years). This is approximately 2 per 1000, one tenth of the rate of 2% to 5% for developing symptomatic thrombosis after elective hip surgery.

Vasa, 2016

Venous thromboembolism (VTE) is a major cause of maternal morbidity during pregnancy and the postpartum period. However, because there is a lack of adequate study data, management strategies for pregnancy-associated VTE must be deduced from observational studies and extrapolated from recommendations for non-pregnant patients. In this review, the members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH) have summarised the evidence that is currently available in the literature to provide a practical approach for treating pregnancy-associated VTE. Because heparins do not cross the placenta, weight-adjusted therapeutic-dose low molecular weight heparin (LMWH) is the anticoagulant treatment of choice in cases of acute VTE during pregnancy. No differences between once and twice daily LMWH dosing regimens have been reported, but twice daily dosing seems to be advisable, at least peripartally. It remains unclear whether determining dose adjustments according to factor Xa activities during pregnancy provides any benefi t. Management of delivery deserves attention and mainly depends on the time interval between the diagnosis of VTE and the expected delivery date. In particular, if VTE manifests at term, delivery should be attended by an experienced multidisciplinary team. In lactating women, an overlapping switch from LMWH to warfarin is possible. Anticoagulation should be continued for at least 6 weeks postpartum or for a minimum period of 3 months. Although recommendations are provided for the treatment of pregnancy-associated VTE, there is an urgent need for well-designed prospective studies that compare different management strategies and defi ne the optimal duration and intensity of anticoagulant treatment.

American Journal of Obstetrics and Gynecology, 2006

The purpose of this study was to estimate the incidence, risk factors, and mortality from pregnancy-related venous thromboembolism.The Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality for the years 2000 to 2001 was queried for all pregnancy-related discharges with a diagnosis of venous thromboembolism.The rate of venous thromboembolism was 1.72 per 1000 deliveries with 1.1 deaths per 100,000. The risk of venous thromboembolism was 38% higher for women ages 35 and older and 64% higher for black women. Other significant risk factors included thrombophilia, lupus, heart disease, sickle cell disease, obesity, fluid and electrolyte imbalance, postpartum infection, and transfusion. The risk factor with the highest odds ratio, 51.8 (38.7-69.2) was thrombophilia.The incidence of pregnancy-related venous thromboembolism was higher than generally quoted. Women ages 35 and older, black women, and women with certain medical conditions and obstetric complications appear to be at increased risk.

The Journal of Maternal-Fetal & Neonatal Medicine, 2020

Background and objective: Obstetric venous thromboembolism (VTE) poses a life-threating burden and it is one of the major causes of maternal morbidity and mortality with an increased incidence throughout the last decades. The objectives of this study were to assess the incidence of VTE, types of prophylaxis received and factors determining prophylaxis in women at VTE risk during pregnancy and puerperium at a tertiary hospital for one year. Methods: This is a prospective study that was carried out at Minia maternity university hospital, Egypt during the period from June 2018 to June 2019. The study included women attended the hospital at risk of VTE as per the RCOG guidelines. Full history, patient characteristics and VTE risk factors were assessed. Results: During the study period, a total of 901 women attended the hospital and perceived at risk of VTE (298 cases during pregnancy and 603 cases during puerperium), about half of them were mild in intensity. They comprise 8.22% of the total deliveries during the study period (n=10956). About two-thirds of them (71.5%) had a caesarean delivery. Varicose veins were found in 209 cases (23.2%), previous VTE in 189 cases (21.0%), previous superficial vein thrombosis was recorded in 240 cases (26.6%) and previous arterial ischemic events in 83 cases (9.2%). The vast majority of patients (99.6%) received the pharmacological type of prophylaxis (55.6% of them received unfractionated heparin and the rest of them 43.9% received Aspirin). Only 6 cases developed VTE from the total included cases with an incidence of 0.55/1000 maternities (0.055%). Obesity (BMI >30 kg/m2) and cesarean delivery were significant factors that determine VTE prophylaxis with an odds ratio of 1.68 (95% CI, 1.20-2.35, p<0.01) and 2.05 (95% CI, 1.49-2.80, p<0.01), respectively. Conclusion: The incidence of women perceived at VTE risk during the study period was 8.22% "which is lower than other studies", about half of them were mild in intensity. The risk of VTE was higher during the postpartum period than that during pregnancy. The incidence of VTE was 0.55/1000 overall maternities (0.055%). The pharmacological type of prophylaxis was the predominant used type. Obesity and cesarean delivery were significant factors determining VTE prophylaxis. Further large-scale prospective studies with longer duration are warranted to confirm our findings.