Maternal and Perinatal Outcomes of VTE

Maternal and perinatal outcomes of venous thromboembolism in high-risk cohort using a multidisciplinary treatment approach

Adapted from Ernst DM et al. Int J Gynecol Obstet. 2021;154(3): 500–507.

Key Takeaway

Perinatal surveillance of pregnant women with a high-risk of VTE should include guided thromboprophylaxis and close observation to decrease perinatal risk
Multidisciplinary assessment of VTE in high-risk pregnant women should be supported
Women at high risk of thrombosis during pregnancy are at high risk of pre-eclampsia, preterm delivery, and growth restriction

Why This Matters

Pregnant women are at >4 times higher risk of VTE compared with nonpregnant women¹
Thromboprophylaxis in these patients is guided by a low level of evidence due to limited data from RCT^2,3
Risk of VTE is five-fold higher during puerperium
An alternative approach in these patients is development of protocols for risk stratification and pharmacological thromboprophylaxis

Study Design

A cohort of pregnant women prospectively referred to the multidisciplinary clinic of the Maternal-Fetal Group of the Red de Salud UC-Christus for a high risk of VTE between January 1, 2007 to December 31, 2019 were analyzed

Inclusion criteria
All pregnant women

Exclusion criteria
Women seeking preconception advice regarding the risk of VTE who did not become pregnant during the period of the analysis

A modified diagnostic workup algorithm and a therapeutic algorithm were developed based on consensus guidelines

Key Results

Patient population

Total of 148 pregnancies included
Median age: 32 years, 26% patients >35 years

Clinical characteristics

High risk VTE: 57% (n=85)

Diagnostic workup

Thrombophilia: 57% (n=85)
Most common thrombophilia was APS (34%; n=29), more frequent in women with obstetric conditions than with prior VTE episodes

ASA and LMWH therapy

VTE under prophylactic or therapeutic treatment was 0% during pregnancy and 3% during puerperium

Perinatal outcomes

Obstetric complications among live births (%)

Limitations

Study design does not indicate if the chosen treatment management option was better than other alternatives
Lack of control group (due to ethical reasons)
Additional efforts are warranted to decrease perinatal risk