Key result
In women with a previous COC-associated VTE, the incidence of thrombotic recurrence was 49.6 per 1,000 patient-years during pregnancy and 118.7 per 1,000 patient-years during puerperium.
Why the study?
Few data are available on thrombotic outcomes during pregnancy and puerperium occurring after an initial provoked venous thromboembolic event.
What is the rate of VTE recurrence during pregnancy and puerperium in women with a prior COC-associated VTE receiving LMWH thromboprophylaxis?
Cohort (n=2,145)
Yes
What is the rate of VTE recurrence during pregnancy and puerperium in women with a prior COC-associated VTE receiving LMWH thromboprophylaxis?
Answers are grounded in this paper and cite their sources.
Women with a prior COC-associated VTE face a significant risk of recurrence during subsequent pregnancies and puerperium despite LMWH prophylaxis.
BACKGROUND: Few data are available on thrombotic outcomes during pregnancy and puerperium occurring after an initial provoked venous thromboembolic (VTE) event. OBJECTIVES: To describe thrombotic outcomes during pregnancy after a first combined oral contraceptive (COC)-associated VTE and the factors associated with recurrence. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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Gris et al. (2022) conducted a cohort in Pregnancy after combined oral contraceptive-associated venous thromboembolism (n=2,145). Pregnancy after previous COC-associated VTE was evaluated on Thrombotic recurrences during pregnancy and puerperium. In women with a previous COC-associated VTE, the incidence of thrombotic recurrence was 49.6 per 1,000 patient-years during pregnancy and 118.7 per 1,000 patient-years during puerperium.
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