Differential haemostatic risk factors for pregnancy-related deep-vein thrombosis and pulmonary embolism

Astrid Bergrem; Anders E. A. Dahm; Anne Flem Jacobsen; Leiv Sandvik; Per Morten Sandset

doi:10.1160/TH12-05-0350

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2012; 108(06): 1165-1171
DOI: 10.1160/TH12-05-0350

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Differential haemostatic risk factors for pregnancy-related deep-vein thrombosis and pulmonary embolism

A population-based case-control study

Astrid Bergrem

¹Departement of Haematology, Oslo University Hospital, Oslo, Norway

²Research Institute of Internal Medicine, Oslo, Norway

³University of Oslo, Institute of Clinical Medicine, Oslo, Norway

,

Anders E. A. Dahm

¹Departement of Haematology, Oslo University Hospital, Oslo, Norway

²Research Institute of Internal Medicine, Oslo, Norway

,

Anne Flem Jacobsen

⁴Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway

,

Leiv Sandvik

⁵Clinical Research, Oslo University Hospital, Oslo, Norway

,

Per Morten Sandset

¹Departement of Haematology, Oslo University Hospital, Oslo, Norway

²Research Institute of Internal Medicine, Oslo, Norway

³University of Oslo, Institute of Clinical Medicine, Oslo, Norway

› Institutsangaben

Abstract

Summary

Limited data exist on thrombophilia and the risk of venous thrombosis (VT) during pregnancy and postpartum. The objectives of the present study were to investigate the role of haemostatic risk factors for pregnancy-related VT and their phenotypic expression in deep-vein thrombosis (DVT) and pulmonary embolism (PE). Total 313 cases with objectively verified first time VT and 353 controls were selected from a source population of 377,155 women with 613,232 pregnancies. The adjusted odds ratio (aOR) for pregnancy-related VT was 1.7 (95% confidence interval [CI] 1.1–2.8) for women with factor VIII >90th percentile. The aOR for VT for endogenous thrombin potential and D-dimer values >90^thpercentiles were 1.8 (95% CI 1.1–3.0) and 2.1 (95% CI 1.3–3.3), respectively. Factor IX >90^thpercentile or free protein S ≤the 5^th percentile increased the risk for PE, and the aORs were 2.4 (95% CI 1.1–5.0) and 3.1 (95% CI 1.3–7.2), respectively. Women carrying the factor V Leiden (F5 rs6025) polymorphism, or who had reduced sensitivity to activated protein C (aPC) in the absence of F5 rs6025, had increased risk for DVT, with unadjusted ORs 7.7 (95% CI 4.7–12.7) and 3.5 (95% CI 2.2–5.4), respectively. Women with a history of pregnancy-related VT showed activation of coagulation and had elevated factor VIII. Furthermore, high levels of factor IX and low levels of free protein S were associated with increased risk for PE, whereas aPC resistance and F5 rs6025 were risk factors for DVT and not PE.

Keywords

Venous thrombosis - deep-vein thrombosis - pulmonary embolism - pregnancy - thrombophilia

Volltext

Referenzen

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