Risk of a Thrombotic Event after the 6-Week Postpartum Period

Abstract

Background The postpartum state is associated with a substantially increased risk of thrombosis. It is uncertain to what extent this heightened risk persists beyond the conventionally defined 6-week postpartum period. Methods Using claims data on all discharges from nonfederal emergency departments and acute care hospitals in California, we identified women who were hospitalized for labor and delivery between January 1, 2005, and June 30, 2010. We used validated diagnosis codes to identify a composite primary outcome of ischemic stroke, acute myocardial infarction, or venous thromboembolism. We then used conditional logistic regression to assess each patient's likelihood of a first thrombotic event during sequential 6-week periods after delivery, as compared with the corresponding 6-week period 1 year later. Results Among the 1,687,930 women with a first recorded delivery, 1015 had a thrombotic event (248 cases of stroke, 47 cases of myocardial infarction, and 720 cases of venous thromboembolism) in the period of 1 year plus up to 24 weeks after delivery. The risk of primary thrombotic events was markedly higher within 6 weeks after delivery than in the same period 1 year later, with 411 events versus 38 events, for an absolute risk difference of 22.1 events (95% confidence interval [CI], 19.6 to 24.6) per 100,000 deliveries and an odds ratio of 10.8 (95% CI, 7.8 to 15.1). There was also a modest but significant increase in risk during the period of 7 to 12 weeks after delivery as compared with the same period 1 year later, with 95 versus 44 events, for an absolute risk difference of 3.0 events (95% CI, 1.6 to 4.5) per 100,000 deliveries and an odds ratio of 2.2 (95% CI, 1.5 to 3.1). Risks of thrombotic events were not significantly increased beyond the first 12 weeks after delivery. Conclusions Among patients in our study, an elevated risk of thrombosis persisted until at least 12 weeks after delivery. However, the absolute increase in risk beyond 6 weeks after delivery was low. (Funded by the National Institute of Neurological Disorders and Stroke.)

Development and validation of risk prediction model for venous thromboembolism in postpartum women: multinational cohort study

“…Although the performance of our model remained unchanged when we excluded women already given thromboprophylaxis, we have probably underestimated this proportion of women in the English data owing to unavailability of prescriptions emanating from secondary care. We believe, however, that thromboprophylaxis practices would be unlikely to have a huge effect on our estimates, as the risk of venous thromboembolism is significantly high well beyond the recommended intervention period of up to seven days29 (guideline changed to 10 days in 20155) after delivery for the vast majority of women at high risk 30. Furthermore, evidence suggests inadequate use of thromboprophylaxis,31 32 a belief supported by the finding of no significant change in the incidence of postpartum venous thromboembolism over time in our English data along with the recent increase in national venous thromboembolism related deaths observed in the UK 2…”

Recommendations for Thrombopropylaxis in Obstetrics and Gynaecology-A SASOG Guideline

“…[15] The hypercoagulability of pregnancy persists for several weeks after delivery and the greatest risk for VTE is in the early postpartum period. [16] The recent decline in maternal deaths from VTE can be attributed to the use of thromboprophylaxis in high-risk women. [1] There are multiple risk factors which increase the risk of VTE.…”

Terhesség és akut ischaemiás stroke

“…A haemostaseologiai változások -feltehetően a placenta eltávolításakor az anyai keringésbe jutó thromboplasticus anyagok következtében -legkifejezettebbek a szülés körüli és közvetlen post partum időszakban, és körülbelül a szülést követő három héttel térnek vissza a kiindulási értékre [10]. Mindazonáltal a szülés után 12 hétig szignifikánsan emelkedett a thromboticus esemé-nyek (stroke, myocardialis infarctus, vénás thromboembolia) kockázata a nem terhes állapothoz képest [11].…”