Venous thromboembolism in pregnancy: 21-year trends

Stein, Paul D.; Hull, Russell D.; Kayali, Fadi; Olson, R. E.; Alshab, Andrew K.; Meyers, Frederick A.; Ghali, William A.; Silbergleit, Allen; Gibson, Paul

doi:10.1016/j.amjmed.2004.02.021

Cited by 55 publications

(23 citation statements)

References 18 publications

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“…Several reports have suggested increased clinician awareness and widespread adoption of computed tomographic pulmonary angiography to test for PE as possible explanations for significant increases in the incidence of PE that was noted in hospitalized patients. 3,17 The prevalence of VTE-associated pregnancy hospitalizations (0.18%) in the present study is consistent with previous reports. 4,11 Although other studies have indicated that the prevalence of VTE is highest during the postpartum period, 4 we found that the rate of VTEassociated hospitalization was generally lower for postpartum hospitalizations than delivery hospitalizations.…”

Section: Commentsupporting

confidence: 93%

Trends in venous thromboembolism among pregnancy-related hospitalizations, United States, 1994-2009

Ghaji

Boulet

Tepper

et al. 2013

American Journal of Obstetrics and Gynecology

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OBJECTIVE-The purpose of this study was to evaluate national trends in the rate of pregnancyrelated hospitalizations for venous thromboembolism (VTE) from 1994-2009 and to estimate the prevalence of comorbid conditions among these hospitalizations.STUDY DESIGN-An estimated 64,413,973 pregnancy-related hospitalizations among women 15-44 years old were identified in the 1994-2009 Nationwide Inpatient Sample. Trends in VTEassociated pregnancy hospitalizations were evaluated with the use of variance-weighted least squares regression. Chi-square tests were used to assess changes in prevalence of demographics and comorbid conditions, and multivariable logistic regression was used to evaluate the likelihood of VTE during the study period after adjustment for comorbid conditions. Antepartum, delivery, and postpartum hospitalizations were evaluated separately and reported in 4-year increments. [1994][1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005][2006][2007][2008][2009], there was a 14% increase in the rate of overall VTE-associated pregnancy hospitalizations; antepartum and postpartum hospitalizations with VTE increased by 17% and 47%, respectively. Between 199417% and 47%, respectively. Between -199717% and 47%, respectively. Between and 200617% and 47%, respectively. Between -2009, the prevalence of hypertension and obesity doubled among all VTE-associated pregnancy hospitalizations; significant increases in diabetes mellitus and heart disease were also noted. A temporal increase in the likelihood of a VTE diagnosis in pregnancy was observed for antepartum hospitalizations from 2006-2009 when compared with 1994-1997 (adjusted odds ratio, 1.62; 95% confidence interval, 1.48-1.78). RESULTS-FromCONCLUSION-There has been an upward trend in VTE-associated pregnancy hospitalizations from 1994-2009 with concomitant increases in comorbid conditions. Clinicians should have a heightened awareness of the risk of VTE among pregnant women, particularly among those with comorbid conditions, and should have a low threshold for evaluation in women with symptoms or signs of VTE.

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Section: Commentsupporting

confidence: 93%

Trends in venous thromboembolism among pregnancy-related hospitalizations, United States, 1994-2009

Ghaji

Boulet

Tepper

et al. 2013

American Journal of Obstetrics and Gynecology

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“…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 …”

Section: Discussionunclassified

“…As trombofilias são frequentes nesses pacientes, sendo a deficiência de proteína S a mais relacionada 9 . Na gravidez e no parto, a tríade de Virchow está presente: o sistema de coagulação está hiperativado, o fluxo venoso está mais lento e há trauma dos vasos (principalmente pélvicos) durante o parto, trauma este que tende a ser maior na cesariana 2,12,[16][17][18] . A principal alteração no sistema de coagulação é um estado trombótico, especialmente no final da gravidez e no parto [16][17][18][19] .…”

Section: Introductionunclassified

“…Na gravidez e no parto, a tríade de Virchow está presente: o sistema de coagulação está hiperativado, o fluxo venoso está mais lento e há trauma dos vasos (principalmente pélvicos) durante o parto, trauma este que tende a ser maior na cesariana 2,12,[16][17][18] . A principal alteração no sistema de coagulação é um estado trombótico, especialmente no final da gravidez e no parto [16][17][18][19] . Há um aumento importante dos fatores I, V, VII, VIII, IX, X, XII e de von Willebrand e diminuição da atividade fibrinolítica, os quais voltam ao normal logo após o parto 2 .…”

Section: Introductionunclassified

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Trombose de veia renal no puerpério: relato de caso

Hillmann¹,

Steffens²,

Trapani³

2015

Rev. Bras. Ginecol. Obstet.

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ResumoDurante a gravidez e o puerpério, existe um estado de hipercoagulabilidade sanguínea e, portanto, de risco para eventos tromboembólicos. A trombose de veia renal é uma condição grave, pouco frequente e de difícil diagnóstico. Este estudo relatou um caso de trombose de veia renal numa puérpera, descrevendo caso clínico, fatores de risco, métodos diagnósticos e o tratamento instituído. AbstractPregnancy and puerperium are periods of blood hypercoagulability and, therefore, of risk for thromboembolic events. Renal vein thrombosis is a serious and infrequent condition of difficult diagnosis. This study reported a case of renal vein thrombosis in the puerperium, and described the clinical case, risk factors, diagnostic methods, and treatment instituted.

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“…Some showed the rate of pregnancy-associated DVT was twice the rate of nonpregnancyassociated DVT.159 A 6-fold increase in the rate of thromboembolism during pregnancy and the puerperium compared with nonpregnant women has been reported by others. 160 Although the rate of pregnancy-associated DVT was higher than the rate of nonpregnancyassociated DVT, the rate of pregnancyassociated PE was lower than Pathophysiology of venous thromboembolism during Pregnancy:…”

Section: Pregnancymentioning

confidence: 99%