Postpartum Venous Thromboembolism: Altitudinal Gradients, Decadal Trends, and PE-Specific Risk Profiling in Highland Populations.

BACKGROUND

This study primarily analyzed differences in venous thromboembolism (VTE) characteristics across altitudes and their temporal trends during the puerperium. Additionally, it identified independent risk factors for postpartum pulmonary embolism (PE).

METHODS

This retrospective study reviewed all postpartum VTE cases at People's Hospital of Xizang Autonomous Region between 2015 and 2024.

RESULTS

This cohort study of 172 postpartum women (median age 31 [IQR 26-36]) compared high-altitude (HA, n = 109) and very high-altitude (VHA, n = 63) groups. PE proportion was significantly higher in VHA vs. HA ( p = 0.033). VHA subjects also showed significant elevated preterm delivery (p = 0.033) and ≥ 3 deliveries (p < 0.001). Joinpoint regression (2015-2024) revealed biphasic trends: significant early-phase escalations in VTE (APC = 18.05%) and deep vein thrombosis (DVT) (APC = 19.66%) during 2015-2022 (p < 0.05), followed by clinically relevant (though statistically nonsignificant) late-phase reductions. PE proportion demonstrated a significant overall increase (APC = 18.77%, p < 0.05). In multivariate analysis, four independent predictors significantly increased PE risk: altitude gradient (OR 1.035, p < 0.001), multiparity (OR 2.548, p = 0.004), hypertension or eclampsia (OR 1.797, p = 0.001), and structural heart disease (OR 1.988, p < 0.001).

CONCLUSION

This decade-long analysis (2015-2024) revealed significant altitudinal gradients in postpartum VTE. Clinically significant escalation of postpartum VTE burden in high-altitude populations warrants urgent intervention. Integrated multiparity management and enhanced comorbidity control are critical future initiatives for resolving key perinatal thrombotic risk bottlenecks.