Trends in the Incidence of Venous Thromboembolism during Pregnancy or Postpartum: A 30-Year Population-Based Study

Heit, John A.; Kobbervig, Catie E.; James, Andra H.; Petterson, Tanya M.; Bailey, Kent R.; Melton, L. Joseph

doi:10.7326/0003-4819-143-10-200511150-00006

Cited by 1,211 publications

(699 citation statements)

References 33 publications

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“…In a Singaporean study examining the psychosocial consequences of confinement practices, Chee et al (2005) found that a negative confinement experience was associated with depression. It is also recognised that the behavioural restrictions and reduced mobility enforced during the confinement period places women at increased risk for development of venous thromboembolism (Heit et al, 2005). Steinberg (1996) suggests research is needed to identify those practices, which are unsafe and potentially harmful, thus ought to be discouraged, as well as those which enrich the experience of childbearing and should be retained.…”

Section: Changing Practicesmentioning

confidence: 99%

An exploratory study of traditional birthing practices of Chinese, Malay and Indian women in Singapore

et al. 2012

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Section: Changing Practicesmentioning

confidence: 99%

An exploratory study of traditional birthing practices of Chinese, Malay and Indian women in Singapore

et al. 2012

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“…The risk of venous thromboembolism (VTE) is five times higher in pregnant than in non-pregnant women [1,2]. The incidence of pregnancy-associated VTE varies from 1 in 1000 to 1 in 2000 deliveries [3].…”

Section: Introductionmentioning

confidence: 99%

The risk of first venous thromboembolism during pregnancy and puerperium in double heterozygotes for factor V Leiden and prothrombin G20210A

Martinelli

Battaglioli

Stefano

et al. 2008

Journal of Thrombosis and Haemostasis

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To cite this article: Martinelli I, Battaglioli T, De Stefano V, Tormene D, Valdrè L, Grandone E, Tosetto A, Mannucci PM, on behalf of the GIT (Gruppo Italiano Trombofilia). The risk of first venous thromboembolism during pregnancy and puerperium in double heterozygotes for factor V Leiden and prothrombin G20210A. J Thromb Haemost 2008; 6: 494-8.Summary. Background: The risk of venous thromboembolism (VTE) during pregnancy in double heterozygous carriers of factor (F) V Leiden and prothrombin G20210A is not established. Hence, whether or not these women deserve antithrombotic prophylaxis when pregnant is unknown. Patients and methods: In the frame of a multicenter family study, 52 double heterozygous carriers of FV Leiden and prothrombin G20210A who had remained pregnant at least once before knowledge of thrombophilia, were retrospectively investigated with respect to the occurrence of first VTE during pregnancy and puerperium. They were compared with 104 heterozygous carriers of FV Leiden, 104 of prothrombin G20210A and 104 women without thrombophilia. Results: Double heterozygotes were similar to single heterozygous carriers and non-carriers for the age at first pregnancy, age at testing and rate of full-term pregnancies. No VTE during pregnancy was observed in the four groups of women, whereas in the puerperium it occurred in two double carriers (1.8% of pregnancies, 95% CI: 0.5-6.3), three single FV Leiden carriers (1.5%, 0.5-4.3), two single prothrombin G20210A carriers (1%, 0.2-3.6) and one non-carrier (0.4%, 0-2.5). Conclusions: The risk of first VTE during pregnancy and puerperium in double heterozygous carriers of FV Leiden and prothrombin G20210A is low and similar to that of single carriers. As for single heterozygotes, antithrombotic prophylaxis in asymptomatic double heterozygous carriers appears to be justified only in puerperium.

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“…If LMWH increases the risk of major haemorrhage by 1/200, then for every PE death avoided with LMWH, more than 1000 women experience major haemorrhage. Although an apparent drop in PE deaths in the UK from 2003 to 2008 has been attributed to increased VTE prophylaxis, newer data show no sustained decrease 21, 56, 57. The incidence of fatal PE during 3‐year time periods ending in 2002, 2005, 2008 and 2011 were 1.5, 1.94, 0.79 and 1.26 per 100 000 births 58.…”

Section: Death From Pulmonary Embolismmentioning

confidence: 99%

Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence‐based lens

Kotaska

2018

BJOG

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Based on prediction models and expert opinion, most obstetric venous thromboembolism guidelines recommend low‐molecular‐weight heparin for many postpartum women, including most delivering by caesarean. Scrutiny reveals major oversights: prediction models are based on studies that report asymptomatic deep vein thrombosis; risk estimates are not adjusted for time exposure; and harm caused by heparin has been overlooked. The benefits of heparin are exaggerated and its harms are under‐appreciated. Estimates of the numbers‐needed‐to‐treat and harm are universally lacking. This paper critically reviews the evidence and quantifies the benefit and harm from low‐molecular‐weight heparin in postpartum women with common risk factors.FundingThis work was unsponsored and unfunded.Tweetable abstractRandomised trials should demonstrate more benefit than harm before widespread postpartum low‐molecular‐weight heparin is recommended.

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Trends in the Incidence of Venous Thromboembolism during Pregnancy or Postpartum: A 30-Year Population-Based Study

Cited by 1,211 publications

References 33 publications

An exploratory study of traditional birthing practices of Chinese, Malay and Indian women in Singapore

An exploratory study of traditional birthing practices of Chinese, Malay and Indian women in Singapore

The risk of first venous thromboembolism during pregnancy and puerperium in double heterozygotes for factor V Leiden and prothrombin G20210A

Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence‐based lens

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