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

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.

Pregnancy after Combined Oral Contraceptive-Associated Venous Thromboembolism: An International Retrospective Study of Outcomes

“…The significant rate of VTE recurrences that we observed during the first trimester of pregnancy in a subgroup of treated women, also observed by others, 18 as late pregnancy is more risky than early pregnancy in nontreated women from the general population, 33,34 deserves comments and induces speculations. Identifying this subgroup for specific prophylactic developments is a strategic objective.…”

“…One recent French prospective observational study of VTE recurrences during pregnancy following a first VTE, 18 on 189 women, including 68% after an event provoked by estrogen-containing contraceptives and 32% with inherited thrombophilia, on heterogeneous thromboprophylactic treatment, found VTE recurrence rates apparently higher than ours, but in fact with CIs that overlap ours, both before and after delivery. In terms of absolute numbers, most of their recurrences were during the postpartum period, whereas most of the ones we observed occurred during pregnancy.…”

“…To study exposure to late pregnancy risk factors and as no patients with pregnancy loss before 20 weeks of pregnancy had any recurrence, we only included women with an ongoing pregnancy at 20 weeks. 18 We performed a univariate logistic regression analysis and crude odds ratios were reported with their two-sided 95% confidence intervals ( 95% CIs). Variables with a p -value of less than 0.15 were included in multivariate logistic regression models and adjusted odds ratios (aORs) were computed.…”

“…9 10 11 They are classically associated with a high risk of VTE recurrence in the few available published data. 12 13 14 15 16 17 18 Guidelines recommend antepartum and postpartum thromboprophylaxis for women with a personal history of estrogen-related VTE, 19 20 despite insufficient available evidence on which to base the recommendations 21 and modalities for thromboprophylaxis.…”

A retrospective study on the use of low-molecular-weight heparin for prevention of pregnancy-related recurrent venous thromboembolism and obstetrical complications

“…Low-molecular-weight heparin (LMWH) is the anticoagulant of choice for the prevention and treatment of VTE during pregnancy and it is also thought to be useful in preventing obstetrical complications [16][17][18][19]. Limited data are available on the risk of recurrent VTE without the use of LMWH prophylaxis during pregnancy [8,20]. and low certainty evidence exist on the efficacy of LMWH prophylaxis for the prevention of obstetrical complications both in women with the acquired (i.e.…”