Jerjes-Sánchez Carlos, Rodriguez David, Farjat Alfredo E, Kayani Gloria, MacCallum Peter, Lopes Renato D, Turpie Alexander G G, Weitz Jeffrey I, Haas Sylvia, Ageno Walter, Goto Shinya, Goldhaber Samuel Z, Angchaisuksiri Pantep, Nielsen Joern Dalsgaard, Schellong Sebastian, Bounameaux Henri, Mantovani Lorenzo G, Prandoni Paolo, Kakkar Ajay K
Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud, Instituto de Cardiologia y Medicina Vascular, TecSalud, Monterrey, Mexico.
Thrombosis Research Institute, London, United Kingdom.
TH Open. 2021 Jan 27;5(1):e24-e34. doi: 10.1055/s-0040-1722611. eCollection 2021 Jan.
The risk of venous thromboembolism (VTE) increases during pregnancy and the puerperium such that VTE is a leading cause of maternal mortality. We describe the clinical characteristics, diagnostic strategies, treatment patterns, and outcomes of women with pregnancy-associated VTE (PA-VTE) enrolled in the Global Anticoagulant Registry in the FIELD (GARFIELD)-VTE. Women of childbearing age (<45 years) were stratified into those with PA-VTE ( = 183), which included pregnant patients and those within the puerperium, and those with nonpregnancy associated VTE (NPA-VTE; = 1,187). Patients with PA-VTE were not stratified based upon the stage of pregnancy or puerperium. Women with PA-VTE were younger (30.5 vs. 34.8 years), less likely to have pulmonary embolism (PE) (19.7 vs. 32.3%) and more likely to have left-sided deep vein thrombosis (DVT) (73.9 vs. 54.8%) compared with those with NPA-VTE. The most common risk factors in PA-VTE patients were hospitalization (10.4%), previous surgery (10.4%), and family history of VTE (9.3%). DVT was typically diagnosed by compression ultrasonography (98.7%) and PE by chest computed tomography (75.0%). PA-VTE patients more often received parenteral (43.2 vs. 15.1%) or vitamin K antagonists (VKA) (9.3 vs. 7.6%) therapy alone. NPA-VTE patients more often received a DOAC alone (30.2 vs. 13.7%). The risk (hazard ratio [95% confidence interval]) of all-cause mortality (0.59 [0.18-1.98]), recurrent VTE (0.82 [0.34-1.94]), and major bleeding (1.13 [0.33-3.90]) were comparable between PA-VTE and NPA-VTE patients. Uterine bleeding was the most common complication in both groups. VKAs or DOACs are widely used for treatment of PA-VTE despite limited evidence for their use in this population. Rates of clinical outcomes were comparable between groups.
孕期和产褥期静脉血栓栓塞症(VTE)的风险增加,VTE是孕产妇死亡的主要原因。我们描述了参与全球抗凝药物注册研究(GARFIELD)-VTE的妊娠相关VTE(PA-VTE)女性的临床特征、诊断策略、治疗模式及结局。育龄期(<45岁)女性被分为PA-VTE组(n = 183),包括孕妇和产褥期女性,以及非妊娠相关VTE(NPA-VTE)组(n = 1187)。PA-VTE患者未根据妊娠或产褥期阶段进行分层。与NPA-VTE患者相比,PA-VTE女性更年轻(30.5岁对34.8岁),发生肺栓塞(PE)的可能性更低(19.7%对32.3%),发生左侧深静脉血栓形成(DVT)的可能性更高(73.9%对54.8%)。PA-VTE患者最常见的危险因素是住院(10.4%)、既往手术(10.4%)和VTE家族史(9.3%)。DVT通常通过压迫超声诊断(98.7%),PE通过胸部计算机断层扫描诊断(75.0%)。PA-VTE患者更常单独接受肠外治疗(43.2%对15.1%)或维生素K拮抗剂(VKA)治疗(9.3%对7.6%)。NPA-VTE患者更常单独接受直接口服抗凝剂(DOAC)治疗(30.2%对13.7%)。PA-VTE和NPA-VTE患者的全因死亡率(风险比[95%置信区间]为0.59[0.18 - 1.98])、复发性VTE(0.82[0.34 - 1.94])和大出血(1.13[0.33 - 3.90])风险相当。子宫出血是两组中最常见的并发症。尽管在该人群中使用VKA或DOAC治疗PA-VTE的证据有限,但它们仍被广泛用于治疗PA-VTE。两组的临床结局发生率相当。
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