A risk score for the management of pregnant women with increased risk of venous thromboembolism: a multicentre prospective study.
Patients with thrombophilia and/or a history of venous thromboembolism (VTE) exhibit a high risk of thrombosis during pregnancy. The present multicentre study prospectively assessed a prophylaxis strategy, based on a risk score, in pregnancies with increased risk of VTE. Among 286 patients included in the study, 183 had a personal history of VTE (63.98%) and 191 patients (66.8%) had a thrombophilia marker. Eighty nine (46.6%) thrombophilic women had a personal history of VTE. Patients were assigned to one of three prophylaxis strategies according to the risk scoring system. In postpartum, all patients received low molecular weight heparin (LMWH) prophylaxis for at least 6 weeks. In antepartum, LMWH prophylaxis was prescribed to 61.8% of patients with high risk of VTE. Among them, 37.7% were treated in the third trimester only and 24.1% were treated throughout pregnancy. In this cohort, one antepartum-related VTE (0.35%) and two postpartum-related VTE (0.7%) occurred. No case of pulmonary embolism was observed during the study period. The rate of serious bleeding was 0.35%. There was no evidence of heparin-induced thrombocytopenia or osteoporosis. The use of a risk score may provide a rational decision process to implement safe and effective antepartum thromboprophylaxis in pregnant women at high risk of VTE.
Dargaud
Yesim
Y
Unité d'Hémostase Clinique, Hôpital Edouard Herriot, Université Lyon 1, Lyon, France. ydargaud@univ-lyon1.fr
Rugeri
Lucia
L
Vergnes
Marie Christine
MC
Arnuti
Brigitte
B
Miranda
Paula
P
Negrier
Claude
C
Bestion
Audrey
A
Desmurs-Clavel
Hélène
H
Ninet
Jacques
J
Gaucherand
Pascal
P
Rudigoz
Rene Charles
RC
Berland
Michel
M
Champion
Fabienne
F
Trzeciak
Marie Christine
MC
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D015992:Body Mass Index; D016001:Confidence Intervals; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008423:Maternal Age; D010865:Pilot Projects; D049590:Postpartum Period; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control*; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D019851:Thrombophilia / Q000150:complications* / Q000175:diagnosis; D014427:Twins; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight