Proteinuria and venous thromboembolism in pregnancy: a population-based cohort study

Akbari, Ayub; Kunkel, Elizabeth; Bota, Sarah E.; Harel, Ziv; Gal, Grégoire Le; Cox, C.; Hundemer, Gregory L.; Canney, Mark; Clark, Edward G.; Massicotte‐Azarniouch, David; Eddeen, Anan Bader; Knoll, Greg; Sood, Manish M.

doi:10.1093/ckj/sfaa278

Cited by 3 publications

(1 citation statement)

References 23 publications

(24 reference statements)

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“…Many prior association studies have explored the relationship between kidney diseases, including CKD and proteinuria, and the risk of VTE. 9,31,11,10,8,32 There also have some observational studies investigating the relationship between renal function biomarkers and VTE risk. An MR study has indicated a causal relationship between eGFR decline and increased risk of VTE, 33 while another population-based monitoring study showed a severe decrease in eGFR to be associated with increased long-term recurrence of VTE, bleeding, and overall mortality in patients with VTE.…”

Section: Discussionmentioning

confidence: 99%

Association between genetic risk and renal function for developing venous thromboembolism

Gan,

Guan,

et al. 2024

Preprint

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Background Kidney disease is regarded as a risk factor for venous thromboembolism (VTE), but the association between renal function and the risk of VTE remains unclear. Methods This study was conducted using a sample of 358,723 participants from the UK Biobank. Hazard ratio (HR) and 95% confidence interval (CI) for the risk of VTE incidence associated with renal function levels were estimated using the Cox proportional hazards model based on the baseline exposure measurements. Additionally, the relationship between renal function and cumulative risk of VTE was visualized using Kaplan-Meier curves as well as restricted cubic spline (RCS). Furthermore, this study investigated the combined effects and interactions between renal function biomarkers and genetic predisposition in relation to the risk of VTE onset. Results Biomarkers of renal function in the highest quartile levels (lowest quartile levels for eGFR) were associated with an elevated risk of VTE onset, with HR (95% CI) of 1.21 (1.12–1.30) for urine creatinine, 1.23 (1.13–1.34) for serum creatinine, 1.12 (1.04–1.2) for urea, 1.15 (1.06–1.26) for urate, 1.59 (1.46–1.73) for cystatin C, 1.28 (1.14–1.43) for urine microalbumin, and 1.47 (1.36–1.60) for eGFR. For the joint associations, participants with both high levels of renal function biomarkers (low levels of eGFR) and high genetic risk had the highest risk of developing VTE, with HR (95% CI) of 2.83 (2.46–3.26) for urine creatinine, 2.72 (2.37–3.13) for serum creatinine, 2.49 (2.18–2.84) for urea, and 2.63 (2.26–3.05) for urate, 3.52 (3.01–4.13) for cystatin C, 2.90 (2.33–3.60) for urine microalbumin, and 3.37 (2.86–3.98) for eGFR. Conclusions Elevated levels of urine creatinine, serum creatinine, urea, urate, cystatin C, urine microalbumin, and reduced eGFR would increase the risk of VTE, and there were positive additive effect of renal function and genetic susceptibility on the risk of VTE.

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Section: Discussionmentioning

confidence: 99%

Association between genetic risk and renal function for developing venous thromboembolism

Gan,

Guan,

et al. 2024

Preprint

View full text Add to dashboard Cite

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Research Progress on the Relationship between Peripheral Blood Inflammatory Indicators, Platelet Parameters, Coagulation Indicators and Preeclampsia

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2023

ACM

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Assessment of Risk Factors and Risk Stratification for Venous Thromboembolism (VTE) in Pregnancy: A Study Conducted in A Tertiary Level Hospital

Habib¹,

Zaman²,

Jebunnahar³

et al. 2023

Haematol J Bangladesh

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Background: Pregnancy itself is one of the most provoking factors for the development of venous thromboembolism (VTE) with an incidence of 5-12 per 10 000 pregnancies (from conception to delivery, i.e., 40 weeks) and 3-7 per 10 000 deliveries postpartum (6 weeks).1 Moreover, certain clinical conditions and individual patient profile make each pregnant women more susceptible to develop symptomatic VTE comprising deep vein thrombosis (DVT) and pulmonary embolism (PE). There is no denial of the fact that risk stratification based upon individual risk factors (both clinical and biochemical) during antenatal period will rationalize the implementation of precise antenatal care/ personalized prophylaxis tailored to each pregnant women, ultimately leading to safe and healthy maternal and perinatal outcome. Objective: The objective of this study is to apply the documented assessment scoring system according to the RCOG Guideline 37a mainly based on clinical risk factors to detect and stratify antenatal patient risk of VTE and institute appropriate preventive treatment/advice. Method: This is a prospective cross-sectional study involving 50 antenatal/pregnant women randomly selected over a period of 6 months undergoing antenatal care in Bangladesh Medical College. For the assessment of risk of VTE in these patients, RCOG guideline 37a risk assessment tool was used. (Appendix 1) A score ranging from 0 to 4 or more was objectively found among these patients. Based upon the score, each patient was categorized as high risk, intermediate risk, and lower risk. Then thromboprophylaxis with LMWH (Enoxaparin)/mobilization was advised for variable durations depending upon the timing of presentation and scores. The patients were reassessed after admission and post-delivery using the same tool for change in transient factors and advised according to the score. Implementation of this risk stratification tool resulted in improved patient care and counselling; the pregnancy outcome of each case was followed up. Results: Among the fifty antenatal patients, RCOG guideline 37a risk assessment tool revealed the following scores: one patient scored zero. Eighteen patients scored one. Sixteen patients scored two. Nine patients scored three. Six patients scored four. Those who scored 0 and 1 (19 patients) required no thromboprophylaxis. The sixteen patients with a score of two were advised for post-natal thromboprophylaxis with low molecular weight heparin/ Enoxaparin (LMWH) for 10 days. They were reassessed/ re-scored in the postnatal period for VTE risk and 5 of these patients down scored to one. Thereby they were judged as not to require post-natal thromboprophylaxis and were advised early mobilization and avoidance of dehydration. The remaining 11 patients with a score of two on postnatal review were put on LMWH (Enoxaparin) at a dose of 20 mg daily subcutaneous (s.c.) (<50 kg), 40 mg daily (50-90 kg), 60 mg daily in 2 divided dose (91-130 kg) for 10 days. Conclusion: Pulmonary embolism is a dreaded consequence of VTE in pregnancy and post-partum, resulting in sudden severe maternal morbidity and mortality. Individualized scoring of the risk of VTE or early detection of DVT (deep venous thrombosis) with subsequent treatment /prophylaxis can reduce /eliminate the risk of maternal death related to VTE. Implementation of risk stratification for VTE of antenatal patients has resulted in a change of practice emphasising preventive measures such as mobilisation and anticoagulation according to the objective scoring system. It is clear that the antepartum and postpartum periods have different magnitudes of risk and distinct risk factors for VTE and therefore must be considered separately. As a continuum of care, carefully reviewed post-partum risk factors has also been proposed by the RCOG in the GTG 37a guideline. Low-molecular-weight heparin is safe in pregnancy and post-partum in prophylactic and therapeutic doses and does not require coagulation monitoring by haematological studies. LMW heparin provides advantages over heparin in that it has better bioavailability and longer half-life, simplified dosing, predictable anticoagulant response, lower risk of Heparin induced thrombocytopenia (HIT), and lower risk of osteoporosis. However, if monitoring is necessary particularly in case of ?Class II Obesity, renal insufficiency and presence of mechanical heart valves, anti–factor Xa levels must be measured because LMWH preparations have little effect on activated partial Thromboplastin Time (aPTT).

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Proteinuria and venous thromboembolism in pregnancy: a population-based cohort study

Cited by 3 publications

References 23 publications

Association between genetic risk and renal function for developing venous thromboembolism

Association between genetic risk and renal function for developing venous thromboembolism

Research Progress on the Relationship between Peripheral Blood Inflammatory Indicators, Platelet Parameters, Coagulation Indicators and Preeclampsia

Assessment of Risk Factors and Risk Stratification for Venous Thromboembolism (VTE) in Pregnancy: A Study Conducted in A Tertiary Level Hospital

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