Gris Jean-Christophe, Aoun Joseph, Rzaguliyeva Leyla, Begum Rowshan, Salah Hassan, Tugushi Tatia, Ghani-Chabouk Mohammed, Zibdeh Mazen, Jassar Waleed Al, Abboud Joe, Meziane Nadia, Ajayi Godwin-Olufemi, Hossain Nazli, Pyregov Alexey, Abduljabbar Hassan, Snyman Leon C, Rachdi Radhouane, Tahlak Muna-Abdulrazzaq, Najmutdinova Dilbar
Department of Haematology, University of Montpellier and University Hospital of Nîmes, France.
Sanofi International Region, Antony, France.
TH Open. 2018 Apr 4;2(2):e116-e130. doi: 10.1055/s-0038-1635573. eCollection 2018 Apr.
The clinical burden of obstetric venous thromboembolism (VTE) risk is inadequately established. This study assessed the prevalence and management of VTE risk during pregnancy and postpartum outside the Western world. This international, noninterventional study enrolled adult women with objectively confirmed pregnancy attending prenatal care/obstetric centers across 18 countries in Africa, Eurasia, Middle-East, and South Asia. Evaluations included proportions of at-risk women, prophylaxis as per international guidelines, prophylaxis type, factors determining prophylaxis, and physicians' awareness about VTE risk management guidelines and its impact on treatment decision. Data were analyzed globally and regionally. Physicians ( = 181) screened 4,978 women, and 4,010 were eligible. Of these, 51.4% were at risk (Eurasia, 90%; South Asia, 19.9%), mostly mild in intensity; >90% received prophylaxis as per the guidelines (except South Asia, 77%). Women in Eurasia and South Asia received both pharmacological and mechanical prophylaxes (>55%), while pharmacological prophylaxis (>50%) predominated in Africa and the Middle-East. Low-molecular-weight heparin was the pharmacological agent of choice. Prophylaxis decision was influenced by ethnicity, assisted reproductive techniques, caesarean section, and persistent moderate/high titer of anticardiolipin antibodies, though variable across regions. Prophylaxis decision in at-risk women was similar, irrespective of physicians' awareness of guidelines (except South Asia). A majority (>80%) of the physicians claimed to follow the guidelines. More than 50% of women during pregnancy and postpartum were at risk of VTE, and >90% received prophylaxis as per the guidelines. Physicians are generally aware of VTE risk and comply with guidelines while prescribing prophylaxis, although regional variations necessitate efforts to improve implementation of the guidelines.
产科静脉血栓栓塞症（VTE）风险的临床负担尚未得到充分确定。本研究评估了西方世界以外地区孕期和产后VTE风险的患病率及管理情况。这项国际非干预性研究纳入了在非洲、欧亚大陆、中东和南亚18个国家的产前护理/产科中心接受客观确诊妊娠的成年女性。评估内容包括高危女性的比例、按照国际指南进行的预防措施、预防类型、决定预防措施的因素，以及医生对VTE风险管理指南的认识及其对治疗决策的影响。数据在全球和区域层面进行了分析。医生（n = 181）筛查了4978名女性，其中4010名符合条件。在这些女性中，51.4%有风险（欧亚大陆，90%；南亚，19.9%），大多数风险程度为轻度；超过90%的女性按照指南接受了预防措施（南亚除外，为77%）。欧亚大陆和南亚的女性同时接受了药物和机械预防措施（>55%），而非洲和中东则以药物预防措施为主（>50%）。低分子量肝素是首选的药物。预防措施的决定受种族、辅助生殖技术、剖宫产以及抗心磷脂抗体持续中等/高滴度的影响，尽管各地区情况有所不同。高危女性的预防措施决定相似，无论医生是否了解指南（南亚除外）。大多数（>80%）医生声称遵循指南。超过50%的孕期和产后女性有VTE风险，超过90%的女性按照指南接受了预防措施。医生通常了解VTE风险并在开预防药时遵循指南，尽管存在地区差异，仍需努力改进指南的实施情况。
