title: Women's values and preferences and health state valuations for thromboprophylaxis during pregnancy: A cross-sectional interview.
abstract: BACKGROUND
  Pregnant women with prior venous thromboembolism (VTE) are at risk of recurrence. Prophylaxis with low molecular weight heparin (LWMH) reduces that risk but is inconvenient, costly, and may be associated with increased risks of obstetrical bleeding. The views of pregnant women, crucial when making prophylaxis recommendations, are currently unknown.
  
  
  METHODS
  Cross-sectional international multicenter study. We included women with a history of VTE who were either pregnant or planning pregnancy. We provided information regarding risk of VTE recurrence with and without LMWH and determined participant's willingness to receive LMWH prophylaxis through direct choice exercises, preference-elicitation (utilities) for health states (e.g. burden of LMWH prophylaxis), and a probability trade-off exercise.
  
  
  RESULTS
  Of 123 women, more women at high risk than those at low risk of recurrence (86.4% vs. 60.0%; p = 0.003) chose to use LMWH. The median threshold reduction in VTE at which women were willing to accept use of LMWH, given a 16% risk of VTE without prophylaxis, was 3% (interquartile range: 1 to 6). Participants' evaluation of the relevant health states varied widely and was unrelated to their direct choices to use or not use LMWH.
  
  
  CONCLUSIONS
  Although the majority of women with a previous VTE, pregnant or planning pregnancy choose to take LMWH during pregnancy, a minority –and in low risk women, a large minority– do not. Our results highlight the need for individualized shared decision-making (SDM) in the clinical encounter, and for guideline panels to make weak recommendations in favor of LMWH that make clear the need for SDM.
authors: Shannon M
authors: SM
authors: Bates
authors: Pablo
authors: P
authors: Alonso-Coello
authors: Kari A O
authors: KA
authors: Tikkinen
authors: Shanil
authors: S
authors: Ebrahim
authors: Luciane Cruz
authors: LC
authors: Lopes
authors: Sarah D
authors: SD
authors: McDonald
authors: Qi
authors: Q
authors: Zhou
authors: Elie A
authors: EA
authors: Akl
authors: Ignacio
authors: I
authors: Neumann
authors: Anne Flem
authors: AF
authors: Jacobsen
authors: Yuqing
authors: Y
authors: Zhang
authors: Amparo
authors: A
authors: Santamaría
authors: Joyce Maria
authors: JM
authors: Annichino-Bizzacchi
authors: Per Morten
authors: PM
authors: Sandset
authors: Wael
authors: W
authors: Bitar
authors: Mark H
authors: MH
authors: Eckman
authors: Gordon H
authors: GH
authors: Guyatt
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D010349:Patient Compliance; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology / Q000517:prevention & control*; D012008:Recurrence; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000150:complications / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight