Recurrent venous thromboembolism after pregnancy-associated versus unprovoked thromboembolism

Richard H White, Wee Shian Chan, Hong Zhou, Jeffrey S. Ginsberg

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

It is not known whether women who develop venous thromboembolism (VTE) during pregnancy have a higher or lower incidence of recurrent VTE than women with unprovoked VTE. The aim of the study was to compare the risk of recurrent VTE among women with pregnancy-associated VTE to women with unprovoked VTE. Hospital discharge data identified women age 18-46 years old with pregnancy-associated or unprovoked index VTE between 1994 and 2005. Risk of recurrent VTE was compared between six and 60 months after the index event using both age-matched comparison of disease-free survival and proportional hazard modelling, adjusting for age and other risk factors. The Kaplan-Meier incidence of recurrent VTE in 1085 women with pregnancy-associated VTE was 5.8% versus 10.4% in 7625 women with unprovoked VTE (p=0.02). Twelve of 34 (35%) recurrent events in the pregnancy-associated group occurred during a subsequent pregnancy compared with 29 of 331 (8.7%) events in the unprovoked group (p<0.001). In the risk-adjusted multivariate model, women with pregnancy-associated VTE had a significantly lower risk of recurrent VTE (HR = 0.6, 95%CI=0.4-0.9). Overall, the incidence of recurrent VTE during subsequent pregnancies was higher in the pregnancy group, 21 of 465 (4.5%), than in the unprovoked group, 37 of 1353 (2.7%, RR=1.7, CI:1.0-2.8). Compared to women with unprovoked VTE, women with pregnancy-associated VTE had a significantly lower long-term risk of recurrent VTE but a higher risk of recurrent VTE during a subsequent pregnancy. These findings should be considered when decisions are made about VTE prophylaxis in women with a history of pregnancy-associated VTE.

Original languageEnglish (US)
Pages (from-to)246-252
Number of pages7
JournalThrombosis and Haemostasis
Volume100
Issue number2
DOIs
StatePublished - Aug 2008

Fingerprint

Thromboembolism
Venous Thromboembolism
Pregnancy
Incidence
Reproductive History

Keywords

  • Epidemiology
  • Pregnancy
  • Recurrent
  • Unprovoked
  • Venous thromboembolism

ASJC Scopus subject areas

  • Hematology

Cite this

Recurrent venous thromboembolism after pregnancy-associated versus unprovoked thromboembolism. / White, Richard H; Chan, Wee Shian; Zhou, Hong; Ginsberg, Jeffrey S.

In: Thrombosis and Haemostasis, Vol. 100, No. 2, 08.2008, p. 246-252.

Research output: Contribution to journalArticle

White, Richard H ; Chan, Wee Shian ; Zhou, Hong ; Ginsberg, Jeffrey S. / Recurrent venous thromboembolism after pregnancy-associated versus unprovoked thromboembolism. In: Thrombosis and Haemostasis. 2008 ; Vol. 100, No. 2. pp. 246-252.
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abstract = "It is not known whether women who develop venous thromboembolism (VTE) during pregnancy have a higher or lower incidence of recurrent VTE than women with unprovoked VTE. The aim of the study was to compare the risk of recurrent VTE among women with pregnancy-associated VTE to women with unprovoked VTE. Hospital discharge data identified women age 18-46 years old with pregnancy-associated or unprovoked index VTE between 1994 and 2005. Risk of recurrent VTE was compared between six and 60 months after the index event using both age-matched comparison of disease-free survival and proportional hazard modelling, adjusting for age and other risk factors. The Kaplan-Meier incidence of recurrent VTE in 1085 women with pregnancy-associated VTE was 5.8{\%} versus 10.4{\%} in 7625 women with unprovoked VTE (p=0.02). Twelve of 34 (35{\%}) recurrent events in the pregnancy-associated group occurred during a subsequent pregnancy compared with 29 of 331 (8.7{\%}) events in the unprovoked group (p<0.001). In the risk-adjusted multivariate model, women with pregnancy-associated VTE had a significantly lower risk of recurrent VTE (HR = 0.6, 95{\%}CI=0.4-0.9). Overall, the incidence of recurrent VTE during subsequent pregnancies was higher in the pregnancy group, 21 of 465 (4.5{\%}), than in the unprovoked group, 37 of 1353 (2.7{\%}, RR=1.7, CI:1.0-2.8). Compared to women with unprovoked VTE, women with pregnancy-associated VTE had a significantly lower long-term risk of recurrent VTE but a higher risk of recurrent VTE during a subsequent pregnancy. These findings should be considered when decisions are made about VTE prophylaxis in women with a history of pregnancy-associated VTE.",
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