title: Personalized thromboprophylaxis using a risk score for the management of pregnancies with high risk of thrombosis: a prospective clinical study.
abstract: Essentials Pregnancy is a risk factor for thrombosis. Management of thrombosis risk in pregnancy remains a challenge. Prophylaxis needs to be personalized. Our score may be a helpful tool for the management of pregnancies at high risk of thrombosis.
  
  
  
  Background Patients with thrombophilia and/or a history of venous thromboembolism (VTE) are at risk of thrombosis during pregnancy. A risk score for pregnancies with an increased risk of VTE was previously described by our group (Lyon VTE score). Objectives The aim of this prospective study was to assess the efficacy and safety of our score-based prophylaxis strategy in 542 pregnancies managed between 2005 and 2015 in Lyon University Hospitals. Patients/Methods Of 445 patients included in the study, 36 had several pregnancies during the study period. Among these 445 patients, 279 had a personal history of VTE (62.7%), 299 patients (67.2%) had a thrombophilia marker, and 131 (29.4%) thrombophilic women had a personal history of VTE. During pregnancy, patients were assigned to one of three prophylaxis strategies according to the risk scoring system. Results In the antepartum period, low molecular weight heparin (LMWH) prophylaxis was prescribed to 64.5% of patients at high risk of VTE. Among them, 34.4% were treated in the third trimester only, and 30.1% were treated throughout pregnancy. During the postpartum period, all patients received LMWH for at least 6 weeks. Two antepartum-related VTEs (0.37%; one with a score of < 3 and the other with a score of > 6) and four postpartum-related VTEs (0.73%; three with scores of 3-5 and one with a score of > 6) occurred. No case of pulmonary embolism was observed during the study period. The rate of bleeding was 0.37%. No serious bleeding requiring transfusions or surgery occurred during the study period. Conclusion 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.
authors.affiliation: Unite d'Hemostase Clinique, Hopital Cardiologique Louis Pradel, CHU de Lyon, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Dargaud
authors.affiliation: Unite d'Hemostase Clinique, Hopital Cardiologique Louis Pradel, CHU de Lyon, France.
authors.forename: L
authors.initials: L
authors.lastname: Rugeri
authors.affiliation: Laboratoire d'Explorations Vasculaires, pavillon M, Hopital Edouard Herriot, CHU de Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Fleury
authors.affiliation: Service d'Obstetrique, Hopital Femme Mere Enfant, CHU de Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Battie
authors.affiliation: Service d'Obstetrique, Hopital Femme Mere Enfant, CHU de Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Gaucherand
authors.affiliation: Service d'Obstetrique, Hopital de la Croix Rousse, CHU de Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Huissoud
authors.affiliation: Service d'Obstetrique, Hopital de la Croix Rousse, CHU de Lyon, France.
authors.forename: R C
authors.initials: RC
authors.lastname: Rudigoz
authors.affiliation: Service de Medecine Interne, pavillon O, Hopital Edouard Herriot, CHU de Lyon, France.
authors.forename: H
authors.initials: H
authors.lastname: Desmurs-Clavel
authors.affiliation: Service de Medecine Interne, pavillon O, Hopital Edouard Herriot, CHU de Lyon, France.
authors.forename: J
authors.initials: J
authors.lastname: Ninet
authors.affiliation: Unite d'Hemostase Clinique, Hopital Cardiologique Louis Pradel, CHU de Lyon, France.
authors.forename: M C
authors.initials: MC
authors.lastname: Trzeciak
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001777:Blood Coagulation / Q000187:drug effects*; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D005260:Female; D005602:France; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects; D006785:Hospitals, University; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: Lyon VTE score; low molecular weight heparin; pregnancy; prophylaxis; venous thromboembolism