Personalized thromboprophylaxis using a risk score for the management of pregnancies with high risk of thrombosis: a prospective clinical study
| Autor: | Pascal Gaucherand, C. Huissoud, C. Fleury, C. Battie, Jacques Ninet, Yesim Dargaud, M. C. Trzeciak, Rene Charles Rudigoz, Helene Desmurs-Clavel, Lucia Rugeri |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
medicine.medical_specialty medicine.drug_class Clinical Decision-Making Low molecular weight heparin Hemorrhage 030204 cardiovascular system & hematology Thrombophilia Risk Assessment Decision Support Techniques Hospitals University 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Pregnancy Risk Factors medicine Humans Prospective Studies Risk factor Prospective cohort study Blood Coagulation 030219 obstetrics & reproductive medicine Framingham Risk Score Obstetrics business.industry Pregnancy Complications Hematologic Anticoagulants Venous Thromboembolism Hematology Heparin Low-Molecular-Weight medicine.disease Pulmonary embolism Surgery Treatment Outcome Female France business Postpartum period |
| Zdroj: | Journal of Thrombosis and Haemostasis. 15:897-906 |
| ISSN: | 1538-7836 |
| DOI: | 10.1111/jth.13660 |
| Popis: | Essentials Pregnancy is a risk factor for thrombosis. Management of thrombosis risk in pregnancy remains a challenge. Prophylaxis needs to be personalized. Our score may be a helpful tool for the management of pregnancies at high risk of thrombosis. SummaryBackground Patients with thrombophilia and/or a history of venous thromboembolism (VTE) are at risk of thrombosis during pregnancy. A risk score for pregnancies with an increased risk of VTE was previously described by our group (Lyon VTE score). Objectives The aim of this prospective study was to assess the efficacy and safety of our score-based prophylaxis strategy in 542 pregnancies managed between 2005 and 2015 in Lyon University Hospitals. Patients/Methods Of 445 patients included in the study, 36 had several pregnancies during the study period. Among these 445 patients, 279 had a personal history of VTE (62.7%), 299 patients (67.2%) had a thrombophilia marker, and 131 (29.4%) thrombophilic women had a personal history of VTE. During pregnancy, patients were assigned to one of three prophylaxis strategies according to the risk scoring system. Results In the antepartum period, low molecular weight heparin (LMWH) prophylaxis was prescribed to 64.5% of patients at high risk of VTE. Among them, 34.4% were treated in the third trimester only, and 30.1% were treated throughout pregnancy. During the postpartum period, all patients received LMWH for at least 6 weeks. Two antepartum-related VTEs (0.37%; one with a score of 6) and four postpartum-related VTEs (0.73%; three with scores of 3–5 and one with a score of > 6) occurred. No case of pulmonary embolism was observed during the study period. The rate of bleeding was 0.37%. No serious bleeding requiring transfusions or surgery occurred during the study period. Conclusion The use of a risk score may provide a rational decision process to implement safe and effective antepartum thromboprophylaxis in pregnant women at high risk of VTE. |
| Databáze: | OpenAIRE |
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