Feasibility of an easy-to-use risk score in the prevention of venous thromboembolism and placental vascular complications in pregnant women: a prospective cohort of 2736 women.
BACKGROUND
Management of pregnant women at increased risk of venous thromboembolism (VTE) remains complex in the absence of an easy-to-use tool allowing individualised, risk-adapted prophylaxis. Our objective was to assess whether treatment based on risk score is feasible in these women.


METHODS
A scoring system for VTE risk in pregnant women was developed, each score being associated with a specific treatment. This system was implemented in a prospective cohort of 2736 consecutive women delivered in our teaching hospital from July 2002 to June 2003. Thromboembolic and obstetrical outcomes during pregnancy and the early post-partum period were recorded.


RESULTS
Treatment based on risk score was implemented in 2685 of the 2736 women included (98.1%). The scoring system identified 2431 women with no risk factor and 305 women (11%) with at least one risk factor. Eight women not at risk (0.3%, [95% CI: 0.1-0.5]) and one at risk (0.4%, [95% CI: 0-1.1]) experienced a VTE. This low event rate precluded estimation of the discriminatory power of the score. However, the benefit of the scoring system was evaluated indirectly by assessing VTE incidence in the 46 women at risk in whom it was not used (15.2%, [95% CI: 4.8-25.6]).


CONCLUSIONS
Our simple scoring system offers an easily implemented procedure for risk-based VTE prophylaxis of pregnant women and the proposed therapeutic strategy appears to be effective and safe in reducing VTE. The discriminatory power of the score is currently being evaluated in a randomized, controlled trial.
Chauleur
Céline
C
Gynaecology-Obstetrics Department, EA3065 (Thrombosis Research Group), University Hospital, 42055 Saint-Etienne Cedex 2, France. celine.chauleur@chu-st-etienne.fr
Quenet
Sara
S
Varlet
Marie-Noëlle
MN
Seffert
Pierre
P
Laporte
Silvy
S
Decousus
Hervé
H
Mismetti
Patrick
P
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D015331:Cohort Studies; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D010920:Placenta / Q000098:blood supply*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000517:prevention & control*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D017984:Enoxaparin; D001241:Aspirin