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Thromb Haemost 2020; 120(10): 1454-1462
DOI: 10.1055/s-0040-1714211
Stroke, Systemic or Venous Thromboembolism

Clinical Characteristics and Outcomes of Women Presenting with Venous Thromboembolism during Pregnancy and Postpartum Period: Findings from the RIETE Registry

Islam Y. Elgendy 
1   Division of Cardiology, Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
,
Annemarie Fogerty
2   Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Ángeles Blanco-Molina
3   Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
,
Vladimir Rosa
4   Department of Internal Medicine, Hospital Universitario Virgen de Arrixaca, Murcia, Spain
,
Sebastian Schellong
5   Department of Medical Clinic, Municipal Hospital of Dresden Friedrichstadt, Dresden, Germany
,
Andris Skride
6   Department of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
,
José Portillo
7   Department of Internal Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
,
Patricia Lopez-Miguel
8   Department of Pneumonology, Hospital General Universitario de Albacete, Albacete, Spain
,
Manuel Monreal
9   Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
,
Ido Weinberg
10   Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States
› Author Affiliations Funding None.
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Abstract

Although venous thromboembolism (VTE) is a leading cause of maternal mortality, there is a paucity of real-world clinical data on clinical presentation and management of VTE during pregnancy and postpartum period. Using data from the international RIETE (Registro Informatizado Enfermedad Trombo Embólica) registry, pregnant and postpartum women with VTE were identified. Baseline characteristics, risk factors, therapies, and outcomes were compared. From March 2001 to July 2019, 596 pregnant and 523 postpartum women had symptomatic, objectively confirmed VTE. Pregnant or postpartum women were less likely to have another risk factor for VTE (i.e., immobility, cancer, recent travel) than nonpregnant women aged < 50 years. The prevalence of thrombophilia was higher among pregnant and postpartum women compared with nonpregnant women (53.2% vs. 46%). Pulmonary embolism (PE) was less commonly diagnosed in pregnant versus postpartum women (27% vs. 42%). Pregnant women with PE were commonly treated with low molecular weight heparin (73% vs. 29%), and received more inferior vena cava filters (6.0% vs. 4.2%) compared with postpartum women. By 90 days, one pregnant and one postpartum woman died after PE, and one died after a deep venous thrombosis. The incidence of recurrent VTE was low. In this largest cohort of pregnant and postpartum women with confirmed VTE, we found that pregnant and postpartum women with VTE were unlikely to present with other risk factors for VTE. Adverse outcomes in our study were uncommon.

Keywords

pregnancy - postpartum - pulmonary embolism - venous thromboembolism

Note

The investigators of the RIETE Registry could be found in [Supplementary Appendix A] (available in the online version).


Supplementary Material



Publication History

Received: 25 March 2020

Accepted: 01 June 2020

Article published online:
27 July 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med 2008; 359 (19) 2025-2033
    CrossrefPubMedGoogle Scholar
  • 2 Ghaji N, Boulet SL, Tepper N, Hooper WC. Trends in venous thromboembolism among pregnancy-related hospitalizations, United States, 1994-2009. Am J Obstet Gynecol 2013; 209 (05) 433.e1-433.e8
    CrossrefPubMedGoogle Scholar
  • 3 Lucassen W, Geersing GJ, Erkens PM. , et al. Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med 2011; 155 (07) 448-460
    Google Scholar
  • 4 James AH, Jamison MG, Brancazio LR, Myers ER. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol 2006; 194 (05) 1311-1315
    CrossrefPubMedGoogle Scholar
  • 5 Morris JM, Algert CS, Roberts CL. Incidence and risk factors for pulmonary embolism in the postpartum period. J Thromb Haemost 2010; 8 (05) 998-1003
    PubMedGoogle Scholar
  • 6 Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton III LJ. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 143 (10) 697-706
    CrossrefPubMedGoogle Scholar
  • 7 Bikdeli B, Jimenez D, Hawkins M. , et al; RIETE Investigators. Rationale, design and methodology of the computerized registry of patients with venous thromboembolism (RIETE). Thromb Haemost 2018; 118 (01) 214-224
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Guijarro R, Montes J, Sanromán C, Monreal M. ; RIETE Investigators. Venous thromboembolism in Spain. Comparison between an administrative database and the RIETE registry. Eur J Intern Med 2008; 19 (06) 443-446
    CrossrefPubMedGoogle Scholar
  • 9 Bremme KA. Haemostatic changes in pregnancy. Best Pract Res Clin Haematol 2003; 16 (02) 153-168
    CrossrefPubMedGoogle Scholar
  • 10 Sultan AA, West J, Grainge MJ. , et al. Development and validation of risk prediction model for venous thromboembolism in postpartum women: multinational cohort study. BMJ 2016; 355: i6253
    Google Scholar
  • 11 Lacruz B, Tiberio G, Latorre A. , et al; RIETE Investigators. Venous thromboembolism in young adults: findings from the RIETE registry. Eur J Intern Med 2019; 63: 27-33
    CrossrefPubMedGoogle Scholar
  • 12 Abdul Sultan A, Grainge MJ, West J, Fleming KM, Nelson-Piercy C, Tata LJ. Impact of risk factors on the timing of first postpartum venous thromboembolism: a population-based cohort study from England. Blood 2014; 124 (18) 2872-2880
    CrossrefPubMedGoogle Scholar
  • 13 Shahir K, Goodman LR, Tali A, Thorsen KM, Hellman RS. Pulmonary embolism in pregnancy: CT pulmonary angiography versus perfusion scanning. AJR Am J Roentgenol 2010; 195 (03) W214-20
    CrossrefPubMedGoogle Scholar
  • 14 Cahill AG, Stout MJ, Macones GA, Bhalla S. Diagnosing pulmonary embolism in pregnancy using computed-tomographic angiography or ventilation-perfusion. Obstet Gynecol 2009; 114 (01) 124-129
    CrossrefPubMedGoogle Scholar
  • 15 Chan WS, Spencer FA, Ginsberg JS. Anatomic distribution of deep vein thrombosis in pregnancy. CMAJ 2010; 182 (07) 657-660
    CrossrefPubMedGoogle Scholar
  • 16 Bates SM, Rajasekhar A, Middeldorp S. , et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv 2018; 2 (22) 3317-3359
    CrossrefPubMedGoogle Scholar
  • 17 Konstantinides SV, Meyer G, Becattini C. , et al; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020; 41 (04) 543-603
    CrossrefPubMedGoogle Scholar
  • 18 Blanco-Molina A, Trujillo-Santos J, Criado J. , et al; RIETE Investigators. Venous thromboembolism during pregnancy or postpartum: findings from the RIETE Registry. Thromb Haemost 2007; 97 (02) 186-190
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Blanco-Molina A, Rota LL, Di Micco P. , et al; RIETE Investigators. Venous thromboembolism during pregnancy, postpartum or during contraceptive use. Thromb Haemost 2010; 103 (02) 306-311
    Article in Thieme ConnectPubMedGoogle Scholar