PREGNANCY
THROMBOPROPHYLAXIS
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Previous VTE - Investigation
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J Thromb
Haemost. 2005 May;3(5):949-54.
Risk of pregnancy-associated recurrent venous thromboembolism in women with
a history of venous thrombosis.
Pabinger I, Grafenhofer H, Kaider A, Kyrle PA, Quehenberger P, Mannhalter C,
Lechner K.
Department of Internal Medicine I, Division of Haematology and Blood
Coagulation, Medical University, Vienna, Austria.
ingrid. Pabinger@meduniwien. Ac. At
Background:
Limited data exist on the risk of pregnancy-associated venous
thromboembolism (VTE) in women with a history of VTE.
Objectives:
To evaluate
the risk of recurrent pregnancy-associated thrombosis in women with previous
VTE in a large retrospective cohort study. PATIENTS AND Methods:
One hundred
and fifty-nine women with at least one pregnancy (293 pregnancies in total)
after a VTE were included into the study. The patients underwent a
standardized interview on their history of thrombosis and
pregnancy-associated complications.
Results:
Eight recurrent events occurred
during 197 pregnancies without thrombosis prophylaxis. The probability of
VTE during pregnancy without thrombosis prophylaxis was 6.2% (95% confidence
interval 1.6-10.9%). The risk was constant over the whole period of
pregnancy. Of the eight women with VTE during pregnancy four had
heterozygous FV:R506Q, two in combination with hyperhomocysteinemia. No VTE
occurred during 87 pregnancies with thrombosis prophylaxis. In the
postpartum period 15 VTEs occurred, two of 83 (2.4%) after pregnancy
termination, one of 53 (1.9%) after miscarriage, three of 10 (30%) after
stillbirth and nine of 138 (6.5%) after live birth.
Conclusions:
Without
thrombosis prophylaxis the risk for recurrent symptomatic VTE is substantial
during the whole period of pregnancy in women with previous VTE. The
majority of events occurred after delivery, reflecting the very high risk
during the postpartum period. Prospective and comparative trials to
ascertain efficacy and safety of prophylactic heparin are urgently needed.
   
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