“We know there is a higher risk of blood clots during pregnancy due to factors such as hypercoagulability and venous stasis. Even though our patients are generally young and healthy in the obstetric population, we do see a fair number of venous thromboembolisms,” says Alexander M. Friedman, MD, MPH, a maternal-fetal medicine specialist at NewYork-Presbyterian/
A thrombosis formation
To answer these questions, Dr. Friedman and his colleagues at Columbia, including Jason D. Wright, MD, Chief of the Division of Gynecologic Oncology, undertook a retrospective cohort study of deliveries occurring from 2008 to 2014 using the MarketScan Commercial and Medicaid databases. Of the 4,128,900 pregnancies, they identified 4,267 women aged 15 to 54 years diagnosed with acute venous thromboembolism (VTE) during pregnancy, the delivery hospitalization, or ≤60 days postpartum who received at least one prescription postpartum for anticoagulants. In their study, the research team analyzed risks of chronic pulmonary embolism (PE) and postthrombotic syndrome at 6, 12, 24, and 60 months after delivery hospitalization.
“There is not a lot of data on long-term outcomes or complications after these events,” says Dr. Friedman. “Our study found that overall risk of chronic complications after obstetric deep vein thrombosis was relatively low for both postthrombotic syndrome and chronic pulmonary embolism. In fact, the risk for pulmonary embolism approximates that of the general population.”
Specifically, the study results showed:
- 61.8% of patients (2,637) had a DVT alone
- 25.8% (1,103) had a PE event alone
- 12.4% (527) had both DVT and PE events
For patients who had a DVT only, the risk of postthrombotic syndrome was:
- 0.7% (17) at 6 months
- 1.1% (22) at 12 months
- 1.7% (26) at 24 months
- 2.7% (16) at 60 months
Among women with PE diagnoses, the risk of chronic PE was:
- 2.4% (30) at 6 months
- 3.3% (36) at 12 months
- 4.2% (36) at 24 months
- 7.2% (24) at 60 months
“It is important for clinicians to be aware of the potential for DVT events and promptly diagnose and treat them,” notes Dr. Friedman. “In terms of long-term consequences, based on the study
the implication is that these events are pertinent in terms of the medical history. Therefore, we would encourage women to follow up with their primary care providers to make them aware of their clinical history. We recommend watchful waiting so that if they subsequently develop any symptoms of chronic pulmonary embolism or postthrombotic syndrome in the future, they can be evaluated with the right diagnostic testing and treated promptly.”
