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PREGNANCY
THROMBOPROPHYLAXIS
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Previous VTE - Investigation
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N Engl J
Med. 2000 Nov 16;343(20):1439-44.
Safety of withholding heparin in pregnant women with a history of venous
thromboembolism. Recurrence of Clot in This Pregnancy Study Group.
Brill-Edwards P, Ginsberg JS, Gent M, Hirsh J, Burrows R, Kearon C, Geerts
W, Kovacs M, Weitz JI, Robinson KS, Whittom R, Couture G; Recurrence of Clot
in This Pregnancy Study Group.
McMaster University Medical Centre, Hamilton, Ont, Canada.
Background:
Women with a history of venous thromboembolism may be at
increased risk for venous thromboembolic events during pregnancy. In these
women, the decision to give or withhold heparin in the antepartum period is
controversial, because accurate estimates of the frequency of recurrent
thromboembolic events if antepartum heparin is withheld are not available.
Methods:
We prospectively studied 125 pregnant women with a single previous
episode of venous thromboembolism. Antepartum heparin was withheld, but
anticoagulant therapy was given for four to six weeks post partum. Our
primary objective was to determine the rate of antepartum recurrence of
venous thromboembolism. Laboratory studies were performed to identify
thrombophilia in 95 women.
Results:
Three of the 125 women (2.4 percent) had
an antepartum recurrence of venous thromboembolism (95 percent confidence
interval, 0.2 to 6.9 percent). There were no recurrences in the 44 women who
had no evidence of thrombophilia and who also had a previous episode of
thrombosis that was associated with a temporary risk factor. Among the 51
women with abnormal laboratory results or a previous episode of idiopathic
thrombosis, or both, 3 (5.9 percent) had an antepartum recurrence of venous
thromboembolism (95 percent confidence interval, 1.2 to 16.2 percent).
Conclusions:
The risk of recurrent antepartum venous thromboembolism in
women with a history of venous thromboembolism is low, and therefore routine
antepartum prophylaxis with heparin is not warranted.
  
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