Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium—a register-based case-control study

Jacobsen, Anne Flem; Skjeldestad, Finn Egil; Sandset, Per Morten

doi:10.1016/j.ajog.2007.08.041

Cited by 354 publications

(276 citation statements)

References 20 publications

Supporting

Mentioning

246

Contrasting

Unclassified

Order By: Relevance

“…Odds ratios are calculated for various risk factors while the database as a whole is used as a denominator to calculate incidence 24, 25, 26, 27, 28. Case–control studies are often used to investigate rare phenomena; however, they are designed to evaluate relative not absolute risks and they do not reliably determine the underlying frequency of events 29.…”

Section: Overestimating the Incidence Of Vtementioning

confidence: 99%

“…VTE are typically identified using unverified diagnostic codes, allowing women with suspected VTE and those receiving LMWH for prophylaxis rather than treatment to be inappropriately included. A Norwegian study that validated every episode of postpartum VTE found that half of coded diagnoses were inaccurate 27. Also, similarity of codes for superficial, septic and deep venous thrombophlebitis and amniotic fluid and venous pulmonary embolism inflate the incidence of VTE 30, 31, 32…”

Section: Overestimating the Incidence Of Vtementioning

confidence: 99%

“…As most women are only treated for the first 3–10 days after birth, these estimates exaggerate the benefit of LMWH. To improve clinical relevance, recent studies report the incidence per antenatal or postpartum week 27, 41, 42, 43, 44. These studies provide the best estimates of absolute VTE risk for the period during which LMWH prophylaxis is typically given.…”

Section: Adjusting Vte Incidence For Timementioning

confidence: 99%

“…Of all VTE episodes, fewer than 1% are fatal 27, 31, 54, 55. For an average woman after CD, the risk of death from PE in the first week postpartum is approximately 0.4/100 000.…”

Section: Death From Pulmonary Embolismmentioning

confidence: 99%

“…A physiological balance exists between clot formation and dissolution and it is difficult to identify which women will develop VTE. Fewer than half of postpartum VTE occur within the first 2 weeks and 50% of these women have one or no risk factors 27, 42, 44…”

Section: Lessons Of Evidence‐based Medicinementioning

confidence: 99%

See 4 more Smart Citations

Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence‐based lens

Kotaska

2018

BJOG

View full text Add to dashboard Cite

Based on prediction models and expert opinion, most obstetric venous thromboembolism guidelines recommend low‐molecular‐weight heparin for many postpartum women, including most delivering by caesarean. Scrutiny reveals major oversights: prediction models are based on studies that report asymptomatic deep vein thrombosis; risk estimates are not adjusted for time exposure; and harm caused by heparin has been overlooked. The benefits of heparin are exaggerated and its harms are under‐appreciated. Estimates of the numbers‐needed‐to‐treat and harm are universally lacking. This paper critically reviews the evidence and quantifies the benefit and harm from low‐molecular‐weight heparin in postpartum women with common risk factors.FundingThis work was unsponsored and unfunded.Tweetable abstractRandomised trials should demonstrate more benefit than harm before widespread postpartum low‐molecular‐weight heparin is recommended.

show abstract

Section: Overestimating the Incidence Of Vtementioning

confidence: 99%

Section: Overestimating the Incidence Of Vtementioning

confidence: 99%

Section: Adjusting Vte Incidence For Timementioning

confidence: 99%

“…Of all VTE episodes, fewer than 1% are fatal 27, 31, 54, 55. For an average woman after CD, the risk of death from PE in the first week postpartum is approximately 0.4/100 000.…”

Section: Death From Pulmonary Embolismmentioning

confidence: 99%

Section: Lessons Of Evidence‐based Medicinementioning

confidence: 99%

See 3 more Smart Citations

Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence‐based lens

Kotaska

2018

BJOG

View full text Add to dashboard Cite

show abstract

Preeclampsia and Long-Term Risk of Venous Thromboembolism

Havers-Borgersen,

Butt,

Johansen

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceAs venous thromboembolism (VTE) remains one of the leading causes of maternal mortality, identifying women at increased risk of VTE is of great importance. Preeclampsia is a pregnancy-induced hypertensive disorder with generalized endothelial dysfunction. Some studies suggest that preeclampsia is associated with an increased risk of VTE, but much controversy exists.ObjectiveTo examine the association between preeclampsia and the risk of VTE during pregnancy, during the puerperium, and after the puerperium.Design, Setting, and ParticipantsThis observational cohort study used Danish nationwide registries to identify all eligible primiparous women who gave birth in Denmark from January 1, 1997, to December 31, 2016. The women were followed up from primiparous pregnancy to incident VTE, emigration, death, or the end of the study (December 31, 2016). Statistical analyses were carried out from January to May 2023.ExposurePreeclampsia during primiparous pregnancy.Main Outcomes and MeasureThe main outcome was incident VTE, and the secondary outcome was all-cause mortality.ResultsA total of 522 545 primiparous women (median age, 28 years [IQR, 25-31 years]) were included, and 23 330 (4.5%) received a diagnosis of preeclampsia. Women with preeclampsia were of similar age to women without preeclampsia but had a higher burden of comorbidities. During a median follow-up of 10.2 years (IQR, 5.2-15.4 years), preeclampsia was associated with a higher incidence of VTE compared with no preeclampsia (incidence rate, 448.8 [95% CI, 399.9-503.5] vs 309.6 [95% CI, 300.6-319.9] per 1000 patient-years, corresponding to an unadjusted hazard ratio [HR] of 1.45 [95% CI, 1.29-1.63] and an adjusted HR of 1.43 [95% CI, 1.27-1.61]). When stratified according to the subcategories of VTE, preeclampsia was associated with an increased rate of deep vein thrombosis (unadjusted HR, 1.51 [95% CI, 1.32-1.72] and adjusted HR, 1.49 [95% CI, 1.31-1.70]) as well as pulmonary embolism (unadjusted HR, 1.39 [95% CI, 1.09-1.76]; adjusted HR, 1.36 [95% CI, 1.08-1.73]). These findings held true in landmark analyses during pregnancy, during the puerperium, and after the puerperium.Conclusions and RelevanceThis cohort study suggests that preeclampsia was associated with a significantly increased risk of VTE during pregnancy, during the puerperium, and after the puerperium, even after thorough adjustment. Future studies should address how to improve the clinical management of women with a history of preeclampsia to prevent VTE.

show abstract

Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period

Middleton

Shepherd

Gomersall

2021

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium—a register-based case-control study

Cited by 354 publications

References 20 publications

Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence‐based lens

Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence‐based lens

Preeclampsia and Long-Term Risk of Venous Thromboembolism

Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period

Contact Info

Product

Resources

About