Incidence of Pregnancy-Associated Venous Thromboembolism: Second Nationwide Study

Hun-Gyu Hwang; Ju Hyun Lee; Soo-Mee Bang

doi:10.1055/a-2019-0607

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2023; 123(09): 904-910
DOI: 10.1055/a-2019-0607

Stroke, Systemic or Venous Thromboembolism

Incidence of Pregnancy-Associated Venous Thromboembolism: Second Nationwide Study

Hun-Gyu Hwang

¹Division of Respiratory, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine, Republic of Korea

,

Ju Hyun Lee

²Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea

,

Soo-Mee Bang

²Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea

› Institutsangaben

Abstract

Background Pregnancy is a transient risk factor for venous thromboembolism (VTE). This second nationwide study aimed to inspect trend changes in the incidence rate of pregnancy-associated VTE (PA-VTE) during the study period (2014–2018) compared with that reported in a previous study (2006–2010).

Methods Using the Korean Health Insurance Review and Assessment Service database, we retrospectively identified all PA-VTE events using both diagnostic and medication codes.

Results Of the 124,228 VTE events, 510 (0.4%) cases of PA-VTE were identified in 499 women (median age: 34 years; range: 20–49 years). The incidence rate of PA-VTE/10,000 deliveries (PA-VTE/10⁴D) in this second study (2.62) was 3.2 times higher than that in the first study (0.82). In the second study, the PA-VTE/10⁴D ratio of women in their 40s (5.46) was three times higher than that of women in their 20s (1.80) (relative risk: 3.03; 95% confidence interval: 2.04–4.51; p < 0.01). The incidence rate for women in their 40s in the second study was 2.3 times higher than that in the first study. PA-VTE/10⁴D cases occurred more frequently in multiparous than in primiparous women, in cesarean section cases compared with vaginal delivery, and in multiple rather than single pregnancies. Most PA-VTE cases occurred during the postpartum period (321/510, 62.9%), of which pulmonary embolism was the most frequently occurring type (231/321, 72%).

Conclusion Advanced maternal age, cesarean section, multiparity, and multifetal pregnancies increased the risk of PA-VTE. Obstetricians need to be cautious of VTE, particularly during the postpartum period, in high-risk pregnant patients.

Keywords

pregnancy - venous thromboembolism - age - cesarean section - multiparity - multifetal pregnancies

Volltext

Referenzen

References
1 Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJ. Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost 2008; 6 (04) 632-637
2 Middeldorp S, Naue C, Köhler C. Thrombophilia, thrombosis and thromboprophylaxis in pregnancy: for what and in whom?. Hamostaseologie 2022; 42 (01) 54-64
3 Jang MJ, Bang SM, Oh D. Incidence of pregnancy-associated venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost 2011; 9 (12) 2519-2521
4 Hart C, Bauersachs R, Scholz U. et al. Prevention of venous thromboembolism during pregnancy and the puerperium with a special focus on women with hereditary thrombophilia or prior VTE-position paper of the working group in women's health of the Society of Thrombosis and Haemostasis (GTH). Hamostaseologie 2020; 40 (05) 572-590
5 Jaya-Bodestyne SL, Lee LH, Tan LK. et al. Risk factors for pregnancy-associated venous thromboembolism in Singapore. J Perinat Med 2020; 49 (02) 153-158
6 Won HS, Kim DY, Yang MS, Lee SJ, Shin HH, Park JB. Pregnancy-induced hypertension, but not gestational diabetes mellitus, is a risk factor for venous thromboembolism in pregnancy. Korean Circ J 2011; 41 (01) 23-27
7 Kim L, Kim JA, Kim S. A guide for the utilization of Health Insurance Review and Assessment Service National Patient Samples. Epidemiol Health 2014; 36: e2014008
8 Jang MJ, Bang SM, Oh D. Incidence of venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost 2011; 9 (01) 85-91
9 Hong J, Lee JH, Yhim HY. et al. Incidence of venous thromboembolism in Korea from 2009 to 2013. PLoS One 2018; 13 (01) e0191897
10 National Health INsurance Service. Utilization of Medical Services by Region, South Korea in 2014. The 2014 Statistical Yearbook on Utilization of Medical Services by Region. vol. 1; 2015
11 Hwang H-G, Lee JH, Kim S-A. et al. Incidence of venous thromboembolism: the 3^rd Korean nationwide study. J Korean Med Sci 2022; 37 (17) e130
12 Statistics Korea. . Birth Statistics 2020. Accessed August 2021 at: http://kostat.go.kr/portal/korea/kor_nw/1/2/1/index.board
13 Clegg LX, Hankey BF, Tiwari R, Feuer EJ, Edwards BK. Estimating average annual per cent change in trend analysis. Stat Med 2009; 28 (29) 3670-3682
14 Macklon NS, Greer IA. Venous thromboembolic disease in obstetrics and gynaecology: the Scottish experience. Scott Med J 1996; 41 (03) 83-86
15 Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-related mortality in the United States, 2011-2013. Obstet Gynecol 2017; 130 (02) 366-373
16 Korean Society for Assisted Reproduction. . Annual trend of artificial technology by age group. Accessed July 2022 at: http://www.ivfkorea.or.kr/ivf/rate?flag=AC
17 Chung SH, Seol HJ, Choi YS, Oh SY, Kim A, Bae CW. Changes in the cesarean section rate in Korea (1982-2012) and a review of the associated factors. J Korean Med Sci 2014; 29 (10) 1341-1352
18 Ewins K, Ní Ainle F. VTE risk assessment in pregnancy. Res Pract Thromb Haemost 2019; 4 (02) 183-192
19 Raia-Barjat T, Edebiri O, Chauleur C. Venous thromboembolism risk score and pregnancy. Front Cardiovasc Med 2022; 9: 863612
20 Taylor J, Hicks CW, Heller JA. The hemodynamic effects of pregnancy on the lower extremity venous system. J Vasc Surg Venous Lymphat Disord 2018; 6 (02) 246-255
21 Ropacka-Lesiak M, Jarosław K, Bręborowicz G. Pregnancy-dependent blood flow velocity changes in lower extremities veins in venous insufficiency. Ginekol Pol 2015; 86 (09) 659-665
22 Bates SM, Middeldorp S, Rodger M, James AH, Greer I. Guidance for the treatment and prevention of obstetric-associated venous thromboembolism. J Thromb Thrombolysis 2016; 41 (01) 92-128
23 Kamel H, Navi BB, Sriram N, Hovsepian DA, Devereux RB, Elkind MS. Risk of a thrombotic event after the 6-week postpartum period. N Engl J Med 2014; 370 (14) 1307-1315
24 McColl MD, Ramsay JE, Tait RC. et al. Risk factors for pregnancy associated venous thromboembolism. Thromb Haemost 1997; 78 (04) 1183-1188
25 Antic D, Lefkou E, Otasevic V. et al; Balkan Working Group for Prevention and Treatment of Venous Thromboembolism. Position paper on the management of pregnancy-associated superficial venous thrombosis. Clin Appl Thromb Hemost 2022; 28: 1076029620939181
26 Bitsadze V, Khizroeva J, Alexander M, Elalamy I. Venous thrombosis risk factors in pregnant women. J Perinat Med 2022; 50 (05) 505-518
27 James AH, Jamison MG, Brancazio LR, Myers ER. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol 2006; 194 (05) 1311-1315
28 Kearon C, Julian JA, Newman TE, Ginsberg JS. Noninvasive diagnosis of deep venous thrombosis. McMaster Diagnostic Imaging Practice Guidelines Initiative. Ann Intern Med 1998; 128 (08) 663-677

Zusatzmaterial

Supplementary Material