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Clinical Pathology Selected Abstracts, 7/13

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Clinical pathology abstracts editor: Deborah Sesok-Pizzini, MD, MBA, associate professor, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and medical director, Blood Bank and Transfusion Medicine, Children’s Hospital of Philadelphia.

Risk factors for first venous thromboembolism around pregnancy

Venous thromboembolism is a serious maternal complication occurring at a rate of one to two per 1,000 maternities during pregnancy and the puerperium. Venous thromboembolism (VTE) is a leading cause of maternal mortality in developed countries and an important source of morbidity in the form of post-thrombotic syndrome. Women who are at higher risk for VTE require thromboprophylaxis, but it may be challenging to identify these women due to the lack of data about absolute risk factors for VTE. The authors conducted a study in the United Kingdom to identify the level of absolute and relative risks of VTE in accordance with a woman’s pre-existing and pregnancy-related factors in the antepartum and postpartum periods. The primary objective of the study was to identify women requiring obstetric thromboprophylaxis. The study also aimed to estimate the specific absolute risks of VTE in women with low, intermediate, and high-risk pregnancies according to guidelines on who should receive prophylaxis. The authors used a large primary care database of 376,154 pregnancies that ended in live birth or stillbirth from women aged 15 to 44 years between 1995 and 2009. The investigators assessed the impact of risk factors for antepartum and postpartum VTE in terms of absolute risk and incidence rate ratios. Results showed that during the antepartum period, varicose veins, inflammatory bowel disease, urinary tract infection, and pre-existing diabetes were associated with an increased risk of VTE (absolute risk, 139 per 100,000 person-years or greater; incidence rate ratio, 1.8 or greater). In the postpartum period, the greatest risk factor was stillbirth (absolute risk, 2,444 per 100,000 person-years; incidence rate ratio, 6.2) followed by co-morbidities, body mass index of 30 kg/m2 or greater, obstetric hemorrhage, preterm delivery, and Caesarean section (absolute risk, 637 per 100,000 person-years or greater; incidence rate ratio, 1.9 or greater). The authors concluded that VTE risk varies modestly with different risk factors and, except for pre-existing diabetes, risk factors have a greater impact in the postpartum period in terms of affecting the absolute risk of VTE, than in the antepartum period. Study results also showed a low relative increase in the risk of VTE among women over the age of 35, current smokers, and women with a high body mass index during the antepartum period, which are findings consistent with previous studies.

Sultan AA, Tata LJ, West J, et al. Risk factors for first venous thromboembolism around pregnancy: a population based cohort study from the United Kingdom [published online ahead of print April 2, 2013]. Blood. doi:10.1182/blood-2012-11-469551.
Correspondence: Matthew Grainge at mat­thew.grainge@nottingham.ac.uk

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