Recurrence of VTE in Patients with Recent Gestational DVT or PE

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 worldwide^1-3
• VTE during pregnancy or post-partum is an instigated event such as VTE secondary to surgery, prolonged immobilization, oral contraception, trauma, or hormonal replacement therapy^4-8
• 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

Key Results

Of the total 46,770 RIETE registry patients, 607 women were objectively confirmed with VTE during pregnancy or puerperium

• Women with recent surgery showed the incidence of PE more than DVT
• During pregnancy DVT was more common than PE, PE was more common during puerperium
• The most common drug used as initial therapy was LMWH, and then UFH

• The cumulative incidence of VTE recurrence was low at 2 years 3.3% (95% CI, 1.5–5.0)
• Recurrent incidence rate was 2.28 events/100 patients-year
• No significant differences were observed between DVT and PE for initial VTE presentation
• Use of thrombolytics and inferior vena cava filter in initial treatment was associated with increased risk of VTE recurrence

Limitations

RIETE is an observational registry, therefore, results must be interpreted with caution while suggesting changes or adapting any treatment strategies