Postpartum Period Is a Risk Factor for Cerebral Venous Thrombosis

Abstract

Background and Purpose— Pregnancy and the postpartum period are generally considered to be risk factors for cerebral venous thrombosis (CVT), but no controlled studies have quantified the risk. Methods— Case-control study using data of consecutive adult patients with CVT from 5 academic hospitals and controls from the Dutch MEGA study (Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis). Men, women over the age of 50, women using oral contraceptives or with a recent abortion or miscarriage were excluded. We adjusted for age and history of cancer, and stratified for pregnancy versus postpartum, and 0 to 6 versus 7 to 12 weeks postpartum. Results— In total 163/813 cases and 1230/6296 controls were included. Cases were younger (median 38 versus 41 years) and more often had a history of cancer (14% versus 4%) than controls. In total 41/163 (25%) cases and 82/1230 (7%) controls were pregnant or postpartum (adjusted odds ratio, 3.8; 95% CI, 2.4–6.0). The association was fully attributable to an increased risk of CVT during the postpartum period (adjusted odds ratio, 10.6; 95% CI, 5.6–20.0). We found no association between pregnancy and CVT (adjusted odds ratio, 1.2; 95% CI, 0.6–2.3). The risk was highest during the first 6 weeks postpartum (adjusted odds ratio, 18.7; 95% CI, 8.3–41.9). Conclusions— Women who have recently delivered are at increased risk of developing CVT, while there does not seem to be an increased risk of CVT during pregnancy.

Use of oral rivaroxaban in cerebral venous thrombosis

“…It occurs three times more frequently in women, especially during pregnancy and with use of hormonal contraceptives, reaching up to 12 cases per one million deliveries 2 . Risk factors of CVT are different from that of ischemic stroke, with pregnant or postpartum women having 3.5 times higher risk of developing CVT than non-pregnant or postpartum women of similar age 3,4 . Recommended treatment of CVT is anticoagulation unless contraindicated, initially with intravenous unfractionated heparin (UFH) or low molecular weight heparin (LMWH) i.e.…”

CVT in the Peripartum Period: A Diagnostic Dilemma

“…Finally, the patient was at risk for development of CVT by presenting in the immediate postpartum period. A casecontrol study conducted by Silvis et al utilizing cases of CVT across 5 academic hospitals and controls from the Dutch MEGA study detected 41 cases of CVT diagnosed during pregnancy or postpartum (up to 12 weeks) and found that, when adjusted for pregnancy and the postpartum period, the highest attributable risk of development of CVT was during the first 6 weeks postpartum (adjusted odds ratio: 18.7; 95% CI: 8.3-41.9) and, surprisingly, little association 3 Case Reports in Obstetrics and Gynecology between pregnancy itself and CVT (adjusted odds ratio: 1.2; 95% CI: 0.6-2.3) [8]. Therefore, CVT should be strongly considered in the postpartum period for those with intractable headache, as this may confer a tenfold increased risk of CVT than nonpregnant or postpartum women of similar age.…”

“…Furthermore, the risk of CVT is also thought to be increased in those patients with sinusitis, thrombophilias, dehydration, head trauma, and pregnancy [6]. Pregnancy and postpartum status is conceivably one of the most common risk factors and misdiagnosis of CVT as an eclamptic seizure can be frequent [7,8].…”

Pathogenesis and Management in Cerebrovenous Outflow Disorders

“…Both pregnancy and the postpartum period have been widely considered to be common risk factors for CVT; however, recent studies have shown that a higher risk of CVT is associated with the postpartum period, and that pregnancy is not as significant. A multicenter, casecontrol study from the Netherlands in 2019, for instance, indicated that pregnancy did not increase the risk of CVT compared with the control group, while the risk of CVT was increased 10-fold during the postpartum period [21]. In addition, a large, multicenter clinical study (VENOST study) in Turkey involving 1144 patients in 2017 showed both that gynecologic risk factors constituted the largest group of causes of CVT, and that the postpartum period was the most prevalent of all gynecologic risk factors [22].…”