Epidemiology of Pregnancy-associated Venous Thromboembolism: A Population-based Study in Canada

Liu, Shiliang; Rouleau, Jocelyn; Joseph, K.S.; Sauvé, Reg; Liston, Robert; Young, David; Kramer, Michael S.

doi:10.1016/s1701-2163(16)34240-2

Cited by 141 publications

(113 citation statements)

References 27 publications

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“…Although not well studied, women with known antiphospholipid syndrome (APS) and previous VTE seem to be at high risk for recurrent VTE during pregnancy. Two retrospective studies identifi ed APS as a risk factor for pregnancy-related VTE (adjusted OR 5.1 -15.8) [5,23]. The risk of VTE in female APS patients with obstetric complications but without previous VTE is unclear, but seems to be low.…”

Section: Risk Factorsmentioning

confidence: 99%

Diagnosis of pregnancy-associated venous thromboembolism - position paper of the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Linnemann¹,

Scholz

Rott

et al. 2016

Vasa

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EpidemiologyVTE is a leading cause of maternal morbidity in the developed world and, in the case of PE, of mortality as well [1]. While the relative risk of VTE is greatly increased during pregnancy compared with that in non-pregnant women, the absolute risk remains low: estimates of the incidence of pregnancy-associated VTE have varied from 1:500 to 1:1500 pregnancies [2 -7]. The risk of VTE is approximately 5-fold greater in pregnant women than in non-pregnant women.Approximately 80 % of pregnancy-associated VTEs are isolated DVTs, and approximately 20 % are PEs or both DVTs and PEs [5]. Although a systematic review reported weighted event rates for DVT of 21.9 %, 33.7 % and 47.6 % for the fi rst, second and third trimesters, respectively [6], a recent study suggested that the risk might in fact increase exponentially over the duration of the pregnancy [7], with 12.4 % of VTEs diagnosed in the fi rst trimester, 15.3 % in the second trimester and 72.3 % in the third trimester. This detailed risk assessment for each gestational week demonstrated a 21-fold increased risk for the last two weeks before delivery [7]. Summary: Pregnancy and the postpartum period are associated with an increased risk of venous thromboembolism (VTE). Over the past decade, new diagnostic algorithms have been established, combining clinical probability, laboratory testing and imaging studies for the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the non-pregnant population. However, there is no such generally accepted algorithm for the diagnosis of pregnancy-associated VTE. Studies establishing clinical prediction rules have excluded pregnant women, and prediction scores currently in use have not been prospectively validated in pregnancy or during the postpartum period. D-dimers physiologically increase throughout pregnancy and peak at delivery, so a negative D-dimer test result, based on the reference values of non-pregnant subjects, becomes unlikely in the second and third trimesters. Imaging studies therefore play a major role in confi rming suspected DVT or PE in pregnant women. Major concerns have been raised against radiologic imaging because of foetal radiation exposure, and doubts about the diagnostic value of ultrasound techniques in attempting to exclude isolated iliac vein thrombosis grow stronger as pregnancy progresses. As members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH), we summarise evidence from the available literature and aim to establish a more uniform strategy for diagnosing pregnancy-associated VTE. Review Diagnosis of pregnancy-associated

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Section: Risk Factorsmentioning

confidence: 99%

Diagnosis of pregnancy-associated venous thromboembolism - position paper of the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Linnemann¹,

Scholz

Rott

et al. 2016

Vasa

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“…21 A previous VTE and a prior diagnosis of thrombophilia are two risk factors for VTE in pregnant women that can be identified from a patient history before pregnancy. 19,27,28 Studies report that hereditary thrombophilias are observed in 20 to 50% of cases of VTE events in pregnancy. 24,29 Pregnant women who have had a prior VTE are at a 24.8 times greater risk of recurrence.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Certain comorbidities have been associated with increased risk of VTE during pregnancy, including inflammatory intestinal disease, 39 urinary tract infection, 24 systemic lupus erythematosus, heart diseases, 19 systemic arterial hypertension induced by pregnancy or pre-eclampsia, 25,27 and non-obstetric prenatal surgery. 40 An analysis of data from 1,475,301 discharges from Scottish maternity units conducted by Kane et al 27 identified risk factors associated with VTE that included three or more previous pregnancies, obstetric hemorrhage, and pre-eclampsia.…”

Section: Other Risk Factorsmentioning

confidence: 99%

Profilaxia de tromboembolismo venoso na gestação

Oliveira¹,

Marques

2016

J. vasc. bras.

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Venous thromboembolism is a major cause of obstetric morbidity and mortality. During pregnancy, the risk of occurrence increases between five and ten times when compared to women of the same age who are not pregnant. Compounding this is the fact that pregnant women present certain characteristics that make diagnosis more difficult using clinical signs (high frequency of pain and swelling in the lower limbs), echographic examination (lower sensitivity and specificity for diagnosis of iliac vein thrombosis as pregnancy progresses), and laboratory findings (D-dimer levels progressively increase throughout pregnancy). Conducting careful stratification of women' s venous thromboembolism risk before pregnancy could reduce the incidence of this disease, which is frequent and difficult to diagnose during pregnancy, and of its complications.Keywords: venous thrombosis; prophylaxis; pregnancy. ResumoO tromboembolismo venoso é importante causa de morbidade e mortalidade obstétrica. Durante a gestação, o risco de sua ocorrência aumenta entre cinco e dez vezes quando comparado ao de mulheres não gestantes de mesma idade. Associado a esse fato, a gestante apresenta algumas limitações para o diagnóstico clínico (alta frequência de dor e edema nos membros inferiores), ecográfico (menor sensibilidade e especificidade no diagnóstico de trombose venosa de ilíaca com a evolução da gestação) e laboratorial (o D-dímero apresenta aumento progressivo no decorrer da gravidez). Uma estratificação criteriosa de risco de tromboembolismo venoso de cada mulher antes da gestação pode diminuir a incidência dessa doença, frequente e de difícil diagnóstico na gravidez, e suas complicações.

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“…1 According to the 2003 Morbidity and Mortality Weekly Report on pregnancy-related mortality, unspecified embolism was the leading cause of maternal death, at 20%. 2 In 2008, Clark et al 3 published an updated list of causes of maternal death; they were able to distinguish PE from amniotic fluid embolism and found amniotic fluid embolism to be the second most common cause of death at 14%, while PE was the fifth leading cause of death, at 9%.…”

Section: Introductionmentioning

confidence: 99%

“…Published estimates of maternal mortality from DVT or PE are 1.1-1.5 deaths per 100,000 deliveries in North America and Europe. 1,4 Approximately 60%-80% of all VTE related to pregnancy are DVT, 5 and women who experience DVT during pregnancy are more likely to have poorer pregnancy outcomes. 6 Women who have experienced VTE during pregnancy may develop long-term sequelae that range from edema and skin changes to recurrent thrombosis and ulceration.…”

Section: Introductionmentioning

confidence: 99%

Prevention of Venous Thromboembolism in Pregnancy: A Review of Guidelines, 2000–2011

Okoroh

Azonobi

Grosse

et al. 2012

Journal of Women's Health

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Epidemiology of Pregnancy-associated Venous Thromboembolism: A Population-based Study in Canada

Cited by 141 publications

References 27 publications

Diagnosis of pregnancy-associated venous thromboembolism - position paper of the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Diagnosis of pregnancy-associated venous thromboembolism - position paper of the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Profilaxia de tromboembolismo venoso na gestação

Prevention of Venous Thromboembolism in Pregnancy: A Review of Guidelines, 2000–2011

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