Department of Haematology, CHU Nîmes, Univ Montpellier, Nîmes, France.
Faculty of Pharmaceutical and Biological Sciences, Montpellier University, Montpellier, France.
Thromb Haemost. 2022 Oct;122(10):1779-1793. doi: 10.1055/a-1835-8808. Epub 2022 Apr 26.
Few data are available on thrombotic outcomes during pregnancy and puerperium occurring after an initial provoked venous thromboembolic (VTE) event.
To describe thrombotic outcomes during pregnancy after a first combined oral contraceptive (COC)-associated VTE and the factors associated with recurrence.
This was an international multicentric retrospective study on patients referred for thrombophilia screening from January 1, 2010 to January 1, 2021 following a first COC-associated VTE, including women with neither inherited thrombophilia nor antiphospholipid antibodies and focusing on those who had a subsequent pregnancy under the same thromboprophylaxis treatment. Thrombotic recurrences during pregnancy and puerperium as well as risk factors for recurrence were analyzed.
We included 2,145 pregnant women. A total of 88 thrombotic events, 58 antenatal and 29 postnatal, occurred, mostly during the first trimester of pregnancy and the first 2 weeks of puerperium. Incidence rates were 49.6 (37-62) per 1,000 patient-years during pregnancy and 118.7 (78-159) per 1,000 patient-years during puerperium. Focusing on pulmonary embolism, incidence rates were 1.68 (1-4) per 1,000 patient-years during pregnancy and 65.5 (35-97) per 1,000 patient-years during puerperium.Risk factors for antenatal recurrences were maternal hypercholesterolemia and birth of a very small-for-gestational-age neonate. A risk factor for postnatal recurrence was the incidence of preeclampsia.
Our multicentric retrospective data show significant rates of VTE recurrence during pregnancy and puerperium in women with a previous VTE event associated with COC, despite a unique low-molecular-weight heparin-based thromboprophylaxis. These results may provide benchmarks and valuable information for designing future randomized controlled trials.
关于初次诱发静脉血栓栓塞（VTE）事件后妊娠和产褥期发生的血栓形成结局，相关数据较为有限。
描述首次口服避孕药（COC）相关 VTE 后妊娠期间的血栓形成结局，以及与复发相关的因素。
这是一项国际性多中心回顾性研究，纳入了 2010 年 1 月 1 日至 2021 年 1 月 1 日期间因首次 COC 相关 VTE 而接受血栓形成倾向筛查的患者，包括无遗传性血栓形成倾向或抗磷脂抗体的女性，且重点关注那些在相同的血栓预防治疗下随后妊娠的患者。分析了妊娠和产褥期的血栓形成复发以及复发的危险因素。
我们纳入了 2145 名孕妇。共有 88 例血栓形成事件，58 例发生在产前，29 例发生在产后，主要发生在妊娠早期和产褥期的前 2 周。妊娠期间的发生率为 49.6（37-62）/1000 患者年，产褥期的发生率为 118.7（78-159）/1000 患者年。若聚焦于肺栓塞，妊娠期间的发生率为 1.68（1-4）/1000 患者年，产褥期的发生率为 65.5（35-97）/1000 患者年。产前复发的危险因素是母体高胆固醇血症和出生极低体重儿。产后复发的危险因素是子痫前期的发生。
我们的多中心回顾性数据显示，尽管采用了独特的低分子肝素为基础的血栓预防治疗，先前发生过与 COC 相关的 VTE 事件的女性在妊娠和产褥期仍存在较高的 VTE 复发率。这些结果可为设计未来的随机对照试验提供基准和有价值的信息。
