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

Abstract

Venous thromboembolism (VTE), i.e., deep vein thrombosis and pulmonary embolism, are among the main causes of morbidity and mortality in pregnancy with an estimated incidence of 1 per thousand women years. Recommendations on antithrombotic prophylaxis are weak. The aim of the "Pregnancy Health-care Program" (PHP) was to evaluate the individual risk of VTE in a cohort of pregnant women, and manage them with the aim of reducing the rate of VTE. The study was conducted from Jan 2008 to Dec 2010 in the hospital and obstetrical outclinics in Cremona, Italy, and included 1,787 pregnant women who received clinical observation (n = 1,197), above-knee compression stockings (n = 437) or compression stockings and low-molecular-weight heparin (LMWH) (n = 85) depending on their individual VTE risk, evaluated with a risk score (0.5-3.0) derived from the relative risk estimates of a number of risk factors. Visits were scheduled at the end of each trimester and at hospital discharge after delivery. No VTE occurred, but one superficial vein thrombosis was observed 3 days after vaginal delivery in a woman who received clinical observation (0.6 per thousand). No bleeding was observed in LMWH users. The PHP based on stratification of individual VTE risk resulted in a low incidence of VTE events.

Prevention of Venous Thromboembolism in 2020 and Beyond

“…Approaches to individualized risk stratification such as clinical scoring systems have not been well validated in the pregnant population. Prior scoring systems have relied heavily on either personal history of VTE or genetic risk factors, and ultimately these other approaches closely approximate the results of less complex approaches that rely on these factors in isolation [ 99 , 100 , 101 , 102 ]. In cases where the benefits of pharmacologic prophylaxis are not clear, additional risk factors that could be considered include maternal age > 35, BMI > 30 kg/m 2 , twin pregnancy, and immobility as included in the Lyon VTE score [ 100 ], or stillbirth, pre-term birth, prolonged labor, infection, hemorrhage, and blood transfusion as noted by the most recent Royal College of Obstetricians and Gynaecologists (RCOG) guidelines [ 101 , 103 ].…”

Personalized thromboprophylaxis using a risk score for the management of pregnancies with high risk of thrombosis: a prospective clinical study

“…Two of these risk scores are directed towards the general obstetric population , and aim to stratify pregnant women into different risk categories based on the individual characteristics of pregnant women at an obstetric clinic. (i) The Italian pregnancy healthcare program includes 22 risk factors for pregnancy‐related VTE.…”

“…Seventy per cent of patients had clinical observation, 25% had compression stockings, and 5% of patients were treated with LMWH and compression stockings. One superficial vein thrombosis was observed during the postpartum period in a patient at low risk . (ii) The Saint‐Etienne score results, published in 2008, related to 2690 pregnancies corresponding to a general maternity population.…”

Effects of graduated compression stockings, local vibration and their combination on popliteal venous blood velocity

“…intermittent pneumatic compression, neuromuscular electrical stimulation) can be associated with less complications such as lower risk of bleeding and is currently receiving considerable attention. Graduated compression stockings (GCS) are the most widely used because of their proven effectiveness in decreasing venous stasis and preventing deep venous thrombosis in hospital patients 9 and in pregnant women, 10 likely through increased venous blood velocity. In recent years, vibration has become of increasing interest to health professionals, primarily owing to reports that vibration can increase peripheral blood flow and thereby potentially provide physiological benefits in several vascular diseases.…”