Journal of thrombosis and haemostasis : JTH · 2026
Epidemiology of venous thromboembolism during pregnancy and postpartum: results from the French prospective multicenter HEMOrrhage and venous THromboEmbolism in PostPartum study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Laouenan Eloïse, Anouilh François, Courtois-Communier Emmanuelle, de Moreuil Claire, Robin Sara, Le Reun Ségolène, Morcel Karine, Jacquot Matthieu, Bellec Violaine, Muller Matthieu, Tremouilhac Christophe, Touffet Nathalie, Cornec Caroline, Drugmanne Guillaume, Tromeur Cécile, Mottier Dominique, Lacut Karine, Le Mao Raphaël, Espinasse Benjamin, Marhic Gisèle, Lemarié Catherine A, Le Gal Grégoire, Leroyer Christophe, Couturaud Francis, Pan-Petesch Brigitte, Le Moigne Emmanuelle
Аннотация
BACKGROUND: Venous thromboembolism (VTE) prevention in obstetrics remains a major public health concern. Precise data on the timing of VTE events and which women are at risk are necessary to improve thromboprophylaxis strategies.
OBJECTIVES: Primary objective was to determine the incidence of VTE during postpartum. Secondary objectives were: (i) to assess VTE incidence during pregnancy; (ii) to describe VTE risk factors; (iii) to evaluate VTE incidence according to risk stratification and thromboprophylaxis.
METHODS: From June 2015 to January 2019, the prospective cohort "HEMOTHEPP" study included all pregnant women aged ≥16 years admitted for delivery after 15 weeks of gestation in the Finistère region of France (6 maternity units) and followed for 3 months postpartum. An ethics committee approved the study. The primary outcome was symptomatic, documented VTEs-deep vein thrombosis (DVT), pulmonary embolism (PE), or unusual site VTE-as adjudicated by an independent committee.
RESULTS: Among the 20 238 included women, VTE incidence was 4.9 per 1000 person-years (95% CI, 3.3-7.2) during postpartum and 1.3 per 1000 person-years (95% CI, 0.8-2.0) during pregnancy. Postpartum VTEs included 40.0% isolated PEs, 12.0% PE with DVTs, 12.0% isolated DVTs, and 36.0% unusual site VTEs. Of these events, 32.0% occurred during days 0 to 7, 60.0% during days 8 to 42, and 8.0% during days 43 to 90 postpartum. According to the Royal College of Obstetricians and Gynaecologists risk score, 7978 women (39.5%) were classified as intermediate or high risk of postpartum VTE and eligible for thromboprophylaxis; among them, only 3161 (39.6%) received it. Among intermediate-risk women, VTE incidence was similar with or without thromboprophylaxis: 12.0 and 11.8 per 1000 person-years, respectively.
CONCLUSION: Postpartum VTE incidence was twice as high as expected. Thromboprophylaxis during postpartum was underprescribed. The high VTE incidence rate after the first week postpartum and in intermediate-risk women, regardless of thromboprophylaxis, highlights the need for randomized trials to evaluate the benefits of thromboprophylaxis.
OBJECTIVES: Primary objective was to determine the incidence of VTE during postpartum. Secondary objectives were: (i) to assess VTE incidence during pregnancy; (ii) to describe VTE risk factors; (iii) to evaluate VTE incidence according to risk stratification and thromboprophylaxis.
METHODS: From June 2015 to January 2019, the prospective cohort "HEMOTHEPP" study included all pregnant women aged ≥16 years admitted for delivery after 15 weeks of gestation in the Finistère region of France (6 maternity units) and followed for 3 months postpartum. An ethics committee approved the study. The primary outcome was symptomatic, documented VTEs-deep vein thrombosis (DVT), pulmonary embolism (PE), or unusual site VTE-as adjudicated by an independent committee.
RESULTS: Among the 20 238 included women, VTE incidence was 4.9 per 1000 person-years (95% CI, 3.3-7.2) during postpartum and 1.3 per 1000 person-years (95% CI, 0.8-2.0) during pregnancy. Postpartum VTEs included 40.0% isolated PEs, 12.0% PE with DVTs, 12.0% isolated DVTs, and 36.0% unusual site VTEs. Of these events, 32.0% occurred during days 0 to 7, 60.0% during days 8 to 42, and 8.0% during days 43 to 90 postpartum. According to the Royal College of Obstetricians and Gynaecologists risk score, 7978 women (39.5%) were classified as intermediate or high risk of postpartum VTE and eligible for thromboprophylaxis; among them, only 3161 (39.6%) received it. Among intermediate-risk women, VTE incidence was similar with or without thromboprophylaxis: 12.0 and 11.8 per 1000 person-years, respectively.
CONCLUSION: Postpartum VTE incidence was twice as high as expected. Thromboprophylaxis during postpartum was underprescribed. The high VTE incidence rate after the first week postpartum and in intermediate-risk women, regardless of thromboprophylaxis, highlights the need for randomized trials to evaluate the benefits of thromboprophylaxis.