Recurrence of VTE in Patients with Recent Gestational DVT or PE
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Recurrence of venous thromboembolism in patients with recent gestational deep vein thrombosis or pulmonary embolism: Findings from the RIETE Registry
Adapted from Barillari G, et al. European Journal of Internal Medicine. 2016; 32:53-9.
Key Takeaway
- This study provides new insights on VTE recurrence rate in DVT or PE patients during pregnancy and postpartum period
- PE is the most frequent type of VTE occurring in pregnant women with history or recent or previous surgery
- Assessment of thrombotic risk is important for better decision making regarding antithrombotic management
Why This Matters
- 1 in 1000 pregnant women are estimated to have complications due to VTE, which is the leading cause of maternal mortality and morbidity worldwide1-3
- VTE during pregnancy or post-partum is an instigated event such as VTE secondary to surgery, prolonged immobilization, oral contraception, trauma, or hormonal replacement therapy4-8
- There is discrepancy in VTE management in pregnancy among different centers and countries as no clear clinical trials has studied this population
Objective
- To investigate rate of DVT or PE recurrence, major bleeding, or death in women during pregnancy or puerperium
- To identify predictors for VTE recurrence
Study Design
Inclusion criteria: Women confirmed with symptomatic, acute DVT or PE developed during pregnancy or puerperium (up to 42 days after delivery) enrolled in the international, multicenter, prospective RIETE registry
Study period: January 2001 and June 2013
Exclusion criteria: Patient involvement in therapeutic trials with a blind medication or a follow-up of less than three months after the diagnosis
Primary outcome: Recurrent PE (with or without DVT signs), recurrent DVT or major bleeding
Secondary outcome: Fatal VTE and fatal bleeding
Limitations
RIETE is an observational registry, therefore, results must be interpreted with caution while suggesting changes or adapting any treatment strategies
Abbreviations
CI, confidence interval; DVT, deep vein thrombosis; LMWH, low molecular-weight heparin; PE, pulmonary embolism; RIETE, Registro Informatizado de la Enfermedad TromboEmbólica; UFH, unfractionated heparin; VKA, vitamin K antagonists; VTE, venous thromboembolism
References
- Middeldorp S. Thrombosis in women: what are the knowledge gaps in 2013? J Thromb Haemost 2013;11(Suppl. 1):180–91.
- Sultan AA, Tata LJ, West J, et al. Risk factors for first venous thromboembolism around pregnancy: a population-based cohort study from the United Kingdom. Blood 2013;121:3953–61.
- Abdul Sultan A,West J, Tata LJ, Fleming KM, Nelson-Piercy C, Grainge MJ. Risk of first venous thromboembolism in pregnant women in hospital:population-based cohort study from England. BMJ 2013;347:f6099.
- Prandoni P, Noventa F, Ghirarduzzi A, et al. The risk of recurrent venous thromboembolismafter discontinuing anticoagulation in patientswith acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients. Haematologica 2007;92:199–205.
- Christiansen SC, Cannegieter SC, Koster T, Vandenbroucke JP, Rosendaal FR. Thrombophilia, clinical factors, and recurrent venous thrombotic events. JAMA 2005;293:2352–61.
- Palareti G, Legnani C, Cosmi B, Guazzaloca G, Pancani C, Coccheri S. Risk of venous thromboembolism recurrence: high negative predictive value of Ddimer performed after oral anticoagulation is stopped. Thromb Haemost 2002;87:7–12.
- Prandoni P, Lensing AWA, Prins MH, et al. Residual venous thrombosis as a predictive factor of recurrent venous thromboembolism. Ann Intern Med 2002;137: 955–60.
- Hansson PO, Sörbo J, Eriksson H. Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors. Arch Intern Med 2000;160:769–74.
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