Galambosi Päivi J, Ulander Veli-Matti, Kaaja Risto J
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
Thromb Res. 2014 Aug;134(2):240-5. doi: 10.1016/j.thromres.2014.04.026. Epub 2014 May 2.
Recurrent venous thromboembolism (VTE) during pregnancy is a challenging topic with relatively few publications. The aim of this study was to identify the incidence and the risk factors of recurrent antepartum VTE in women with a history of at least one previous VTE episode.
This observational cohort study involved 270 pregnant women (369 pregnancies) with at least one previous episode of VTE. The risk factors of recurrent antepartum VTE were identified by using group A (women without recurrent venous thromboembolism VTE) as a control group for group B (women with recurrent VTE despite LMWH (low molecular weight heparin) prophylaxis) and C (women with VTE recurrence in early pregnancy before the planned initiation of LMWH prophylaxis).
The incidence of recurrent VTE was 7.6% (n=28). Twelve recurrent VTEs in ten women (3.3%) developed during early pregnancy before initiation of LMWH and sixteen recurrent VTEs (4.3%) developed in 15 women despite LMWH prophylaxis. In women with recurrent antepartum VTE, the incidence of a history of two or more previous VTEs (group A vs. B: 5.7% vs. 40.0%, p<0.001; group A vs. C: 5.7% vs. 30.0%, p=0.022), previous VTE in connection with antiphospholipid antibody syndrome (group A vs. B: 2.6% vs. 20.0%, p=0.012) and a history of VTE related to hormonal risk factors (group A vs. B: 60.4% vs. 93.3%, p=0.011) was significantly higher compared to those with successful LMWH-prophylaxis. The percentage of the women with long-term anticoagulation was also significantly higher among the women with recurrent antepartum VTE (group A vs. B: 7.6% vs. 46.7%, p<0.001) compared to those with successful LMWH-prophylaxis. The risk of antepartum recurrent VTE is considerable in women with a history of two or more previous VTEs, antiphospholipid antibody syndrome or long-term anticoagulation. The antepartum prophylaxis with prophylactic dose of LMWH or even with intermediate dose of LMWH might not be sufficient in this high-risk population.
孕期复发性静脉血栓栓塞症（VTE）是一个颇具挑战性的话题，相关出版物相对较少。本研究的目的是确定既往至少有一次VTE发作史的女性产前复发性VTE的发生率及危险因素。
这项观察性队列研究纳入了270名既往至少有一次VTE发作史的孕妇（369次妊娠）。通过将A组（无复发性静脉血栓栓塞症的女性）作为B组（尽管接受低分子量肝素（LMWH）预防仍发生复发性VTE的女性）和C组（在计划开始LMWH预防之前的早孕期间发生VTE复发的女性）的对照组，来确定产前复发性VTE的危险因素。
复发性VTE的发生率为7.6%（n = 28）。10名女性中有12次复发性VTE（3.3%）发生在开始LMWH治疗前的早孕期间，15名女性中有16次复发性VTE（4.3%）尽管接受了LMWH预防仍发生。在产前复发性VTE的女性中，既往有两次或更多次VTE发作史的发生率（A组与B组：5.7%对40.0%，p<0.001；A组与C组：5.7%对30.0%，p = 0.022）、与抗磷脂抗体综合征相关的既往VTE（A组与B组：2.6%对20.0%，p = 0.012）以及与激素危险因素相关的VTE发作史（A组与B组：60.4%对93.3%，p = 0.011）与成功接受LMWH预防的女性相比显著更高。与成功接受LMWH预防的女性相比，产前复发性VTE女性中接受长期抗凝治疗的女性比例也显著更高（A组与B组：7.6%对46.7%，p<0.001）。既往有两次或更多次VTE发作史、抗磷脂抗体综合征或长期抗凝治疗的女性产前复发性VTE的风险相当高。在这一高危人群中，预防性剂量的LMWH甚至中等剂量的LMWH进行产前预防可能并不足够。
