Use of the Delphi method to facilitate antithrombotics prescription during pregnancy.
BACKGROUND
Management of pregnant women at risk for venous thromboembolism (VTE) remains complex. Guidelines do not definitively fix optimal strategies due to limited trial data. Our objective was to build an easy-to-use tool allowing individualised, risk-adapted prophylaxis.


METHODS
A Delphi exercise was conducted to collect 19 French experts' opinions on pregnancy-related VTE.


RESULTS
Experts with an active interest in clinical research and care of VTE and placental vascular complications were selected. The risk score was classified by an anonymous computer vote. A scoring system for VTE risk in pregnant women was developed, each score being associated with a specific treatment: graduated elastic compression stockings, aspirin, prophylactic Low Molecular Weight Heparin (LMWH: variable durations), or adjusted-dose of LMWH through pregnancy and postpartum.


CONCLUSIONS
Our simple consensual scoring system offers an individual estimation of thrombosis risk during pregnancy together with its related therapeutic strategy, in accordance with most of the new international recommendations. The accuracy of our individual risk score-based therapeutic guidance is currently being prospectively evaluated in a multicenter trial.
Chauleur
Celine
C
Gynaecology-Obstetrics Department, EA3065 (Thrombosis Research Group), University Hospital, 42055 Saint-Etienne Cedex 2, Jean Monnet University, France. celine.chauleur@chu-st-etienne.fr
Gris
Jean Christophe
JC
Laporte
Sylvie
S
Rancon
Florence
F
Varlet
Marie-Noëlle
MN
Decousus
Herve
H
Mismetti
Patrick
P
D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D003697:Delphi Technique; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology* / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000209:etiology* / Q000517:prevention & control*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D001241:Aspirin