Risk of pregnancy-associated recurrent venous thromboembolism (VTE) in women with a history of first venous thrombosis
A. Gerhardt1,2, R. E. Scharf2, R. B. Zotz2 (1Ulm, Germany, 2Duesseldorf, Germany)
Women issues in thrombosis and hemostasis
Date: 17.02.2017,
Time: 17:15 - 18:15
Objective: To evaluate the risk of recurrent pregnancy-associated VTE in women with a single previous episode of VTE and a subsequent pregnancy without heparin prophylaxis.
Methods: We included in the study 142 women with at least one pregnancy without heparin prophylaxis after a first VTE. Evaluation of thrombophilia comprised factor V Leiden, prothrombin G20210A mutation, and deficiencies of antithrombin, protein C or protein S.
Results: Nine of 142 women without heparin prophylaxis (6.3%) had an antepartum recurrence of VTE. Among the 66 women with evidence of thrombophilia and a first episode of VTE associated with a temporary risk factor, 4 (6.06%) had an antepartum recurrence of VTE (first trimenon n=1, second trimenon n=2, third trimenon n=1) (first VTE on oral contraceptives (OC) n=3, during surgery n=1). There was no recurrence in the women with thrombophilia and a first episode of idiopathic VTE (n=8). Among the 61 women who had no evidence of thrombophilia and a first episode of VTE associated with a temporary risk factor, 4 women (6.56%) (first trimenon n=2, second trimenon n=1, third trimenon n=1) (first VTE on OC n=1, during immobilization n=1, during surgery n=2), and among 7 women with no evidence of thrombophilia and a first idiopathic VTE, 1 woman (14.3%) had an antepartum recurrence (first trimenon). In the postpartum period, 11 VTE occurred after live birth in 142 women (7.75%). The first episode of VTE in all these women was associated with a temporary risk factor. 7 of these 11 women showed evidence of thrombophilia. Three of 68 women with heparin prophylaxis (4.4%) had an antepartum recurrence of VTE. Among the 32 women with evidence of thrombophilia and a first episode of VTE associated with a temporary risk factor, 3 (6.06%) had an antepartum recurrence of VTE (all factor V Leiden heterozygous) (first trimenon n=1, third trimenon n=2) (first VTE on OC n=2, pregnancy n=1). There was no recurrence in the women without thrombophilia and a first VTE associated with a temporary risk factor (n=36).
Conclusion: In addition to guideline-recommended postpartum heparin prophylaxis, our data also support routine antepartum prophylaxis in women whose previous episode of thrombosis was associated with a transient risk factor not related to pregnancy or use of estrogen, regardless of the presence of thrombophilia and starting in the first trimenon.