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Venous thromboembolism during pregnancy, postpartum or during contraceptive use

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
DOI: https://doi.org/10.1160/TH09-08-0559
Issue: 2010: 103/2 (Feb) pp. 251–479
Pages: 306-311

Venous thromboembolism during pregnancy, postpartum or during contraceptive use

Findings from the RIETE Registry

A. Blanco-Molina (1), L. L. Rota (2), P. Di Micco (3), B. Brenner (4), J. Trujillo-Santos (5), A. Ruiz-Gamietea (6), M. Monreal (7); for the RIETE Investigators

(1) Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain; (2) Department of Thrombosis, Istituto Cliinico Humanitas IRCCS, Rozzano, Milan, Italy; (3) Department of Internal Medicine, Ospedale Buonconsiglio Fatebenefratelli, Naples, Italy; (4) Department of Haematology, Rambam Medical Center, Haifa, Israel; (5) Departmentof Internal Medicine, Hospital Universitario Santa María de Rosell, Cartagena, Murcia, Spain; (6) Department of Internal Medicine, Hospital Universitario Joan XXIII de Tarragona,Tarragona, Spain; (7) Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

Keywords

venous thromboembolism, pregnancy, Contraceptives, postpartum

Summary

Venous thromboembolism (VTE) is a leading cause of maternal death during pregnancy or postpartum, and in women using hormonal contraceptives. However, important issues concerning its natural history and therapy remain unsolved, and most of the protocols for treatment of VTE in this patient population are based on data extrapolated from other populations. RIETE is an ongoing registry of consecutive patients with objectively confirmed, symptomatic, acute VTE. We examined the clinical characteristics and three-month outcome of all enrolled women with pregnancy, postpartum or using hormonal contraceptives. As of December 2008, 173 pregnant women, 135 postpartum, and 798 contraceptive users were enrolled. Of these, 438 (40%) presented with pulmonary embolism (PE) and 668 with deep-vein thrombosis (DVT). Most women with acute PE had dyspnea (72%) or chest pain (75%), but only 2.0% had hypoxaemia. During the three-month study period, five women (0.45%; 95% CI: 0.17–1.00) died (3 had fatal PE), 13 (1.18%; 95% CI: 0.66–1.95) had VTE recurrences, and seven (0.63%; 95% CI: 0.28–1.25) major bleeding. Two of the three women with fatal PE died during the first few hours after arriving at the emergency ward, with no time to start any therapy. The outcome of pregnant or postpartum women with VTE is similar to that in contraceptive users, even though the treatment is different. The non-specific nature of PE signs may have caused some delay in PE diagnosis.

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