Risk factors for first venous thromboembolism around pregnancy: a population-based cohort study from the United Kingdom

Abstract

Key Points• Antepartum, we found that established risk factors only had a modest effect on rates of VTE.• Postpartum, we found that among other factors, women with stillbirth or preterm birth had high rates of VTE.Knowledge of the absolute risk (AR) for venous thromboembolism (VTE) in women around pregnancy and how potential risk factors modify this risk is crucial in identifying women who would benefit most from thromboprophylaxis. We examined a large primary care database containing 376 154 pregnancies ending in live birth or stillbirth from women aged 15 to 44 years between 1995 and 2009 and assessed the effect of risk factors on the incidence of antepartum and postpartum VTE in terms of ARs and incidence rate ratios (IRR), using Poisson regression. During antepartum, varicose veins, inflammatory bowel disease (IBD), urinary tract infection, and preexisting diabetes were associated with an increased risk for VTE (ARs, ‡139/100 000 person-years; IRRs, ‡1.8/100 000 personyears). Postpartum, the strongest risk factor was stillbirth (AR, 2444/100 000 personyears; IRR, 6.2/100 000 person-years), followed by medical comorbidities (including varicose veins, IBD, or cardiac disease), a body mass index (BMI) of 30 kg/m 2 or higher, obstetric hemorrhage, preterm delivery, and caesarean section (ARs, ‡637/100 000 person-years; IRRs, ‡1.9/100 000 person-years). Our findings suggest that VTE risk varies modestly by recognized factors during antepartum; however, women with stillbirths, preterm births, obstetric hemorrhage, caesarean section delivery, medical comorbidities, or a BMI of 30 kg/m 2 or higher are at much higher risk for VTE after delivery. These risk factors should receive careful consideration when assessing the potential need for thromboprophylaxis during the postpartum period. (Blood. 2013;121(19):3953-3961)

Trombose de veia renal no puerpério: relato de caso

“…Os principais fatores de risco para eventos tromboembólicos na gestação e puerpério são idade maior que 30 ou 35 anos 2,5,6,16,18,20,21 , multiparidade 2,5,18,21 , cesariana (principalmente se de urgência) 2,[5][6][7]16,18,[20][21][22] , hipertensão específica da gestação [5][6][7]21 , diabetes gestacional 5 , obesidade 2,4,6,7,[18][19][20]22 , hiperemese gravídica 6 , história pessoal ou familiar de trombose [2][3][4][5]18 , hemorragia pós-parto 2,[5][6][7]22 , anemia falciforme 2,4,19 , lúpus eritematoso sistêmico 4 , infecções ou internações na gravidez 5,6 , trabalho de parto prematuro …”

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

“…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.…”

“…Arguably the best estimates of the incidence of postpartum VTE come from two studies of a large primary‐care database from the UK 41, 42. Sultan et al.…”

“…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…”

Venous thromboembolism in pregnancy and nursing care

“…Yapılan bir çalışmada ise primigravida, sezaryen doğum ve aile öyküsünde DVT olan gebeler DVT açı-sından yüksek riskli olduğu belirtilmektedir (14) . Tablo 1'de gebelikte tromboemboli için risk faktörleri yer almaktadır (15)(16)(17) .…”