A Longitudinal Study of Thrombosis and Bleeding Outcomes With Thromboprophylaxis in Pregnant Women at Intermediate and High Risk of VTE
Background The efficacy and safety of thromboprophylaxis in pregnancy at intermediate to high risk of venous thrombo-embolism (VTE) is an area of ongoing research. Aim This study aimed to assess thrombosis and bleeding outcomes associated with thromboprophylaxis in women at risk of VTE. Methods A co...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2023-03-01
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| Series: | Clinical and Applied Thrombosis/Hemostasis |
| Online Access: | https://doi.org/10.1177/10760296231160748 |
| _version_ | 1797859011560734720 |
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| author | E. Schapkaitz FCPATH E. Libhaber PhD A. Gerber FCOG H. Rhemtula FCOG J. Zamparini FCP B.F Jacobson PhD H.R Büller PhD |
| author_facet | E. Schapkaitz FCPATH E. Libhaber PhD A. Gerber FCOG H. Rhemtula FCOG J. Zamparini FCP B.F Jacobson PhD H.R Büller PhD |
| author_sort | E. Schapkaitz FCPATH |
| collection | DOAJ |
| description | Background The efficacy and safety of thromboprophylaxis in pregnancy at intermediate to high risk of venous thrombo-embolism (VTE) is an area of ongoing research. Aim This study aimed to assess thrombosis and bleeding outcomes associated with thromboprophylaxis in women at risk of VTE. Methods A cohort of 129 pregnancies, who received thromboprophylaxis for the prevention of VTE, were identified from a specialist obstetric clinic in Johannesburg, South Africa. Intermediate-risk pregnancies, with medical comorbidities or multiple low risks, were managed with fixed low-dose enoxaparin antepartum and for a median (interquartile range) of 4 (4) weeks postpartum. High-risk pregnancies, with a history of previous VTE, were managed with anti-Xa adjusted enoxaparin antepartum and for a median of 6 (0) weeks postpartum. Pregnancy-related VTE was objectively confirmed. Major bleeding, clinically relevant nonmajor bleeding (CRNMB) and minor bleeding were defined according to the International Society on Thrombosis and Hemostasis Scientific Subcommittee. Results Venous thrombo-embolism occurred antepartum in 1.4% (95% CI: 0.04-7.7) of intermediate and 3.4% (95% CI: 0.4-11.7) of high-risk pregnancies. Bleeding events occurred in 7.1% (95% CI: 2.4-15.9) of intermediate and 8.5% (95% CI: 2.8-18.7) of high-risk pregnancies. Of these bleeding events, 3.1% (95% CI: 1.0-8.0) were classified as major bleeding. On univariate analysis, no independent predictors of bleeding were identified. Conclusion The rates of thrombosis and bleeding in this predominantly African population were consistent with similar studies and can be used to inform pregnant women of the benefits of anticoagulation and the risks of potential bleeding. |
| first_indexed | 2024-04-09T21:22:35Z |
| format | Article |
| id | doaj.art-4880d5261b3f459eba84b0a02463821b |
| institution | Directory Open Access Journal |
| issn | 1938-2723 |
| language | English |
| last_indexed | 2024-04-09T21:22:35Z |
| publishDate | 2023-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical and Applied Thrombosis/Hemostasis |
| spelling | doaj.art-4880d5261b3f459eba84b0a02463821b2023-03-28T04:03:26ZengSAGE PublishingClinical and Applied Thrombosis/Hemostasis1938-27232023-03-012910.1177/10760296231160748A Longitudinal Study of Thrombosis and Bleeding Outcomes With Thromboprophylaxis in Pregnant Women at Intermediate and High Risk of VTEE. Schapkaitz FCPATH0E. Libhaber PhD1A. Gerber FCOG2H. Rhemtula FCOG3J. Zamparini FCP4B.F Jacobson PhD5H.R Büller PhD6 Department of Molecular Medicine and Hematology, University of Witwatersrand Medical School, Johannesburg, South Africa Department of Research Methodology and Statistics, University of Witwatersrand Medical School, Johannesburg, South Africa Department of Obstetrics, University of Witwatersrand Medical School, Johannesburg, South Africa Department of Obstetrics, University of Witwatersrand Medical School, Johannesburg, South Africa Department of Internal Medicine, University of Witwatersrand Medical School, Johannesburg, South Africa Department of Molecular Medicine and Hematology, University of Witwatersrand Medical School, Johannesburg, South Africa Department of Vascular Medicine, , Amsterdam, the NetherlandsBackground The efficacy and safety of thromboprophylaxis in pregnancy at intermediate to high risk of venous thrombo-embolism (VTE) is an area of ongoing research. Aim This study aimed to assess thrombosis and bleeding outcomes associated with thromboprophylaxis in women at risk of VTE. Methods A cohort of 129 pregnancies, who received thromboprophylaxis for the prevention of VTE, were identified from a specialist obstetric clinic in Johannesburg, South Africa. Intermediate-risk pregnancies, with medical comorbidities or multiple low risks, were managed with fixed low-dose enoxaparin antepartum and for a median (interquartile range) of 4 (4) weeks postpartum. High-risk pregnancies, with a history of previous VTE, were managed with anti-Xa adjusted enoxaparin antepartum and for a median of 6 (0) weeks postpartum. Pregnancy-related VTE was objectively confirmed. Major bleeding, clinically relevant nonmajor bleeding (CRNMB) and minor bleeding were defined according to the International Society on Thrombosis and Hemostasis Scientific Subcommittee. Results Venous thrombo-embolism occurred antepartum in 1.4% (95% CI: 0.04-7.7) of intermediate and 3.4% (95% CI: 0.4-11.7) of high-risk pregnancies. Bleeding events occurred in 7.1% (95% CI: 2.4-15.9) of intermediate and 8.5% (95% CI: 2.8-18.7) of high-risk pregnancies. Of these bleeding events, 3.1% (95% CI: 1.0-8.0) were classified as major bleeding. On univariate analysis, no independent predictors of bleeding were identified. Conclusion The rates of thrombosis and bleeding in this predominantly African population were consistent with similar studies and can be used to inform pregnant women of the benefits of anticoagulation and the risks of potential bleeding.https://doi.org/10.1177/10760296231160748 |
| spellingShingle | E. Schapkaitz FCPATH E. Libhaber PhD A. Gerber FCOG H. Rhemtula FCOG J. Zamparini FCP B.F Jacobson PhD H.R Büller PhD A Longitudinal Study of Thrombosis and Bleeding Outcomes With Thromboprophylaxis in Pregnant Women at Intermediate and High Risk of VTE Clinical and Applied Thrombosis/Hemostasis |
| title | A Longitudinal Study of Thrombosis and Bleeding Outcomes With Thromboprophylaxis in Pregnant Women at Intermediate and High Risk of VTE |
| title_full | A Longitudinal Study of Thrombosis and Bleeding Outcomes With Thromboprophylaxis in Pregnant Women at Intermediate and High Risk of VTE |
| title_fullStr | A Longitudinal Study of Thrombosis and Bleeding Outcomes With Thromboprophylaxis in Pregnant Women at Intermediate and High Risk of VTE |
| title_full_unstemmed | A Longitudinal Study of Thrombosis and Bleeding Outcomes With Thromboprophylaxis in Pregnant Women at Intermediate and High Risk of VTE |
| title_short | A Longitudinal Study of Thrombosis and Bleeding Outcomes With Thromboprophylaxis in Pregnant Women at Intermediate and High Risk of VTE |
| title_sort | longitudinal study of thrombosis and bleeding outcomes with thromboprophylaxis in pregnant women at intermediate and high risk of vte |
| url | https://doi.org/10.1177/10760296231160748 |
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