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Observational Study
. 2022 Apr;20(4):909-918.
doi: 10.1111/jth.15639. Epub 2022 Jan 24.

Risk factors for recurrence during a pregnancy following a first venous thromboembolism: A French observational study

Claire de Moreuil  1   2 , Cécile Tromeur  1   2 , Aurore Daoudal  1 , Christophe Trémouilhac  1   3 , Philippe Merviel  1   3 , François Anouilh  1   4 , Raphaël Le Mao  1   2 , Clément Hoffman  1   2 , Marie Guegan  1 , Elise Poulhazan  5 , Lénaïck Gourhant  1 , Catherine Lemarié  1 , Francis Couturaud  1   2 , Emmanuelle Le Moigne  1   2
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Free article
Observational Study

Risk factors for recurrence during a pregnancy following a first venous thromboembolism: A French observational study

Claire de Moreuil et al. J Thromb Haemost. 2022 Apr.
Free article

Abstract

Background: Women with a previous venous thromboembolism (VTE) are at risk of recurrence during pregnancy.

Objectives: We aimed to assess the incidence rate of recurrent VTE during pregnancy, according to the period of pregnancy, and the clinical parameters associated with recurrence, in a prospective cohort of women of childbearing age after a first VTE.

Patients/methods: A total of 189 women aged 15-49 years with a first documented VTE were followed until a subsequent pregnancy of at least 20 weeks' gestation between 2000 and 2020. VTE recurrences during pregnancy were recorded, as were potential clinical risk factors for recurrence.

Results: Recurrent VTE occurred in six women during antepartum: five during the first trimester (incidence rate 106.4 per 1000 women-years) (95% confidence interval [CI] 46.3-226.0); none during the second trimester; and one during the third trimester (incidence rate 27.0 per 1000 women-years [95% CI 4.8-138.2]). During postpartum, recurrences occurred in 11 women (incidence rate 212.8 per 1000 women-years [95% CI 119.9-349.1]). These 17 recurrent VTEs presented as pulmonary embolism ± deep vein thrombosis (DVT) in five patients and isolated DVT in 12. Failure of thromboprophylaxis occurred in two cases (33.3%) antepartum and in 10 cases (90.9%) postpartum. In multivariable analysis, only obesity (defined on prepregnancy body mass index) was associated with recurrent VTE (odds ratio 3.34 [95% CI 1.11-10.05, p = .03]).

Conclusions: This study confirms a high risk of recurrent VTE postpartum, despite thromboprophylaxis, in women with a previous VTE. Only obesity was associated with VTE recurrence during pregnancy, suggesting that low-dose anticoagulation might not be appropriate in obese pregnant women.

Keywords: obesity; postpartum; pregnancy; recurrence; thromboembolism; thromboprophylaxis.

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References

REFERENCES

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