A risk score for the management of pregnant women with increased risk of venous thromboembolism: a multicentre prospective study

Abstract

Summary Patients with thrombophilia and/or a history of venous thromboembolism (VTE) exhibit a high risk of thrombosis during pregnancy. The present multicentre study prospectively assessed a prophylaxis strategy, based on a risk score, in pregnancies with increased risk of VTE. Among 286 patients included in the study, 183 had a personal history of VTE (63·98%) and 191 patients (66·8%) had a thrombophilia marker. Eighty nine (46·6%) thrombophilic women had a personal history of VTE. Patients were assigned to one of three prophylaxis strategies according to the risk scoring system. In postpartum, all patients received low molecular weight heparin (LMWH) prophylaxis for at least 6 weeks. In antepartum, LMWH prophylaxis was prescribed to 61·8% of patients with high risk of VTE. Among them, 37·7% were treated in the third trimester only and 24·1% were treated throughout pregnancy. In this cohort, one antepartum‐related VTE (0·35%) and two postpartum‐related VTE (0·7%) occurred. No case of pulmonary embolism was observed during the study period. The rate of serious bleeding was 0·35%. There was no evidence of heparin‐induced thrombocytopenia or osteoporosis. The use of a risk score may provide a rational decision process to implement safe and effective antepartum thromboprophylaxis in pregnant women at high risk of VTE.

VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy

“…Several observational studies have evaluated the risk of recurrent VTE with various treatment regimens [36][37][38]44,199,204,[208][209][210][211][212] (Table S18). Some of these studies stratifi ed patients according to their perceived risk of recurrence.…”

A model for calculating the within-subject biological variation and likelihood ratios for analytes with a time-dependent change in concentrations; exemplified with the use of D-dimer in suspected venous thromboembolism in healthy pregnant women

“…As she would have received thromboprophylaxis during pregnancy had this been known, 18 and since we cannot be sure that she did not experience asymptomatic thromboembolism during pregnancy, her results were excluded from the study. The median age for the pregnant women was 31 years (range [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38], median duration of gestation at inclusion was eight weeks (range 5 -13) and median gestational week at delivery was 41 (range 37-42). The pregnancies were uncomplicated, but we included three women with caesarean deliveries (subjects 2, 8 and 16 in Figure 1), and one woman (subject 4, Figure 1) with more than 500 mL blood loss after delivery.…”

“…We therefore suggest that D-dimer should be analysed early in pregnancy in asymptomatic women with risk factors for VTE. 37,38 If a pregnant woman, at risk, later experiences symptoms compatible with VTE, a second blood sample is drawn for D-dimer analysis. The two D-dimer concentrations can then be compared by transforming them into lnMoM as described.…”

“…Four of these women were taking the 'progesterone-only' contraceptive pill, and were included since this has been found not to change the D-dimer concentrations. 19,20 The median age for the non-pregnant women was 33.5 years (range [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40].…”

The “Pregnancy Health-care Program” for the prevention of venous thromboembolism in pregnancy

“…Further studies addressing the management of pregnant women according to their thrombotic risk were claimed [25]. Our study add information to those stemming from other four studies [26][27][28][29] that used a scoring system for the best VTE prevention strategy in pregnant women.…”