Use of a personalized iterative score to evaluate risk of venous thromboembolism during pregnancy and puerperium

Chau, C.; Campagna, Jennifer; Vial, Marine; Rambeaud, C.; Loundou, Anderson; Bretelle, Florence

doi:10.1002/ijgo.12754

Cited by 11 publications

(22 citation statements)

References 24 publications

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“…153 Use of proper thrombo-embolic risk assessment tools have been recently proposed during pregnancy and puerperium demonstrating their efficacy in proper patient management. 154…”

Section: Ulcer Healing and Recurrence A Fundamental Paper Bymentioning

confidence: 99%

Global guidelines trends and controversies in lower limb venous and lymphatic disease

et al. 2019

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Guidelines are fundamental in addressing everyday clinical indications and in reporting the current evidence-based data of related scientific investigations. At the same time, a spatial and temporal issue can limit their value. Indeed, variability in the recommendations can be found both among the same nation different scientific societies and among different nations/continents. On the other side, Garcia already published in 2014 data showing how, after three years in average, one out of five recommendations gets outdated (Martinez Garcia LM, Sanabria AJ, Garcia Alvarez E, et al. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ 2014;186(16):1211–1219). The present document reports a narrative literature revision on the major international recommendations in lower limb venous and lymphatic disease management, focusing on the different countries’ guidelines, trends and controversies from all the continents, while identifying new evidence-based data potentially influencing future guidelines. World renowned experts’ opinions are also provided. The document has been written following the recorded round tables scientific discussions held at the vWINter international meeting (22–26 January 2019; Cortina d’Ampezzo, Italy) and the pre- and post-meeting literature search performed by the leading experts.

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“…153 Use of proper thrombo-embolic risk assessment tools have been recently proposed during pregnancy and puerperium demonstrating their efficacy in proper patient management. 154…”

Section: Ulcer Healing and Recurrence A Fundamental Paper Bymentioning

confidence: 99%

Global guidelines trends and controversies in lower limb venous and lymphatic disease

et al. 2019

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“…Every clinical decision should be based on a detailed, documented risk assessment of the VTE risk of each pregnant woman in early pregnancy, upon modification of any of the risk factors and postpartum. Several VTE risk scores have been devised to guide clinical decision-making [49], some of which have demonstrated clinical significance in guiding appropriate thromboprophylaxis [50,51], and reducing the incidence of VTE [51]. Nevertheless, all of these reports contain limitations in methodology and should be critically assessed by the practicing physician.…”

Section: Vte Prophylaxis In Pregnancymentioning

confidence: 99%

Management of venous thromboembolism in pregnancy

Kalaitzopoulos

Panagopoulos

Samant

et al. 2022

Thrombosis Research

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Venous thromboembolism (VTE) in pregnancy, consisting of deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major factor of maternal mortality. Several patient-specific risk factors along with the physiologic changes of pregnancy promote a state of hypercoagulability in pregnant women. Detailed assessment of all pregnant women can establish a risk profile that would guide clinical decisions, and balance potential therapeutic benefits with side effects. Differentiating between physiologic changes of pregnancy and symptoms of VTE can be challenging and warrants meticulous clinical evaluation. Timely and accurate diagnosis of VTE with proper imaging is essential for its management, and systemic anticoagulation remains the cornerstone of VTE prevention and therapy. Furthermore, advanced invasive treatment options such as inferior vena cava filters and thrombectomy can be considered for complex cases. Importantly, the risk of systemic anticoagulation should be balanced against the risk of VTE-associated morbidity and mortality for mother and fetus, and an informed decision should be made. In this review, we present an up-to-date overview of VTE management in pregnancy and the postpartum period.

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“…Figure 1 summarises the process of identifying and selecting relevant literature. Of the 2268 citations identified, 16 studies [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] investigating 19 unique externally validated RAMs met the inclusion criteria. Only one of these studies 35 presented data on model development and external validation (this study used UK Clinical Practice Research Data linked to Hospital Episode Statistics to develop a risk prediction model and externally validated using Swedish medical birth registry data).…”

Section: Study Flowmentioning

confidence: 99%

“…The studies included in this review evaluated 19 externally validated RAMs [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] and 1 internally validated risk model. 39 While most RAMs focused solely on the estimate of thromboembolic risk, RAMs varied in design, structure, threshold, dosage and duration for pharmacological prophylaxis.…”

Section: Ramsmentioning

confidence: 99%

Risk assessment models for venous thromboembolism in pregnancy and in the puerperium: a systematic review

et al. 2022

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ObjectivesTo assess the comparative accuracy of risk assessment models (RAMs) to identify women during pregnancy and the early postnatal period who are at increased risk of venous thromboembolism (VTE).DesignSystematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesMEDLINE, Embase, Cochrane Library and two research registers were searched until February 2021.Eligibility criteriaAll validation studies that examined the accuracy of a multivariable RAM (or scoring system) for predicting the risk of developing VTE in women who are pregnant or in the puerperium (within 6 weeks post-delivery).Data extraction and synthesisTwo authors independently selected and extracted data. Risk of bias was appraised using PROBAST (Prediction model Risk Of Bias ASsessment Tool). Data were synthesised without meta-analysis.ResultsSeventeen studies, comprising 19 externally validated RAMs and 1 internally validated model, met the inclusion criteria. The most widely evaluated RAMs were the Royal College of Obstetricians and Gynaecologists guidelines (six studies), American College of Obstetricians and Gynecologists guidelines (two studies), Swedish Society of Obstetrics and Gynecology guidelines (two studies) and the Lyon score (two studies). In general, estimates of sensitivity and specificity were highly variable with sensitivity estimates ranging from 0% to 100% for RAMs that were applied to antepartum women to predict antepartum or postpartum VTE and 0% to 100% for RAMs applied postpartum to predict postpartum VTE. Specificity estimates were similarly diverse ranging from 28% to 98% and 5% to 100%, respectively.ConclusionsAvailable data suggest that external validation studies have weak designs and limited generalisability, so estimates of prognostic accuracy are very uncertain.PROSPERO registration numberCRD42020221094.

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Use of a personalized iterative score to evaluate risk of venous thromboembolism during pregnancy and puerperium

Cited by 11 publications

References 24 publications

Global guidelines trends and controversies in lower limb venous and lymphatic disease

Global guidelines trends and controversies in lower limb venous and lymphatic disease

Management of venous thromboembolism in pregnancy

Risk assessment models for venous thromboembolism in pregnancy and in the puerperium: a systematic review

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