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How do we manage venous thromboembolism in pregnancy? A retrospective review of the practice of diagnosing and managing pregnancy‐related venous thromboembolism at two major hospitals in A ustralia and N ew Z ealand
Author(s) -
Chan N.,
Merriman E.,
Hyder S.,
Woulfe T.,
Tran H.,
Chunilal S.
Publication year - 2012
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2012.02863.x
Subject(s) - medicine , pregnancy , caesarean section , obstetrics , venous thromboembolism , epidemiology , post partum , postpartum period , deep vein , retrospective cohort study , dosing , gestation , incidence (geometry) , thrombosis , surgery , genetics , physics , optics , biology
Background N orth A merican and E uropean literature suggest that the incidence rate for pregnancy‐related thromboembolism ( VTE ) ranges from 0.5 to 2 per 1000 pregnancies. However, there is a paucity of data regarding pregnancy‐related VTE in A ustralia and N ew Z ealand. Aims To define the epidemiology, management and adverse effects of pregnancy‐related VTE in A ustralia and N ew Z ealand. Method Retrospective chart review of pregnant patients with objectively diagnosed pregnancy‐related VTE at M onash M edical C entre and the N orth S hore H ospital from J anuary 2007 to M arch 2011. Results Sixty women with VTE were identified, 31 and 29 in the antepartum and post‐partum period respectively. VTE occurred as early as 8 weeks of gestation. There was a trend towards higher proportion of PE in the postpartum period. Most antenatal patients were started on enoxaparin and dosed according to weight at diagnosis. A wide variability in maintenance dosing strategies was observed. Three (5%, 95% CI: 1% to 14%) patients suffered major bleeds, all occurring post‐partum. Recurrences occurred in two post‐partum patients who received a truncated course of enoxaparin for distal deep‐vein thrombosis. Although more women had an induction of labour, this did not translate into an increased Caesarean section rate. Conclusion The epidemiology of pregnancy‐related VTE is similar to that of other developed countries. All three bleeding events occurred in the immediate post‐partum setting, highlighting the need for caution at this critical time. VTE recurrences occurred in those women with post‐partum distal deep‐vein thrombosis treated with an abbreviated course of enoxaparin.