Risk Assessment Model for Postpartum Venous Thromboembolism Prevention in Patients with Systemic Lupus Erythematosus

Abstract

Objective This article assesses the application of the Royal College of Obstetricians and Gynaecologists (RCOG) venous thromboembolism (VTE) risk model on a cohort of postpartum patients with a history of systemic lupus erythematosus (SLE).

Study Design This is a secondary analysis of an ongoing patient registry of women with SLE from 2016 to 2022. There were 49 SLE patients with 55 pregnancies using the Definitions of Remission in SLE (DORIS) criteria to determine SLE disease activity. RCOG risk assessment model scoring was calculated for each patient prior to and after delivery. The primary outcome was the qualification of “active SLE” by standard rheumatologic criteria and assessment of recommendations for VTE prophylaxis based on RCOG VTE risk assessment scoring. Data were analyzed using Fisher's exact test, chi-square test, and Mann–Whitney U test with significance defined as p < 0.05.

Results In the study cohort, 34 pregnancies (61.8%) were in DORIS remission at delivery. Twenty-one pregnancies (38.2%) were not and scored 3 points on the RCOG VTE risk model. Of these pregnancies, only 19% (n = 4) were recommended for VTE prophylaxis by the obstetrical provider despite RCOG score ≥3. Only 35.7% (n = 5) of pregnancies in DORIS remission, but with 3 points for non-SLE-related VTE risk factors (n = 14), were recommended for VTE prophylaxis. Of the 20 pregnancies in remission with an RCOG score < 3 after assessing all risk factors, 15% (n = 3) were nevertheless recommended for VTE prophylaxis. No patients had a postpartum VTE regardless of therapy.

Conclusion These data reveal a need to improve upon providing postpartum VTE prophylaxis to SLE patients not in remission while also recognizing a diagnosis of SLE alone should not equate with active disease. Moreover, SLE patients in remission may still warrant VTE prophylaxis if other non-SLE-related risk factors are present.

Key Points

• Those with SLE are at increased risk for VTE postpartum.

• VTE prophylaxis should be instituted when clinically appropriate.

• Caution should be exercised in broadly assigning disease activity for SLE diagnosis only.

• This study supports VTE prophylaxis use in postpartum patients with SLE.

Keywords

systemic lupus erythematosus - venous thromboembolism - postpartum care

Note

This study was presented at the American College of Rheumatology Convergence 2022 Meeting, ACR, Philadelphia, PA, at November 10–14, 2022.

Condensation

Thromboprophylaxis should be instituted when clinically appropriate with caution exercised when assigning disease activity for the diagnosis of SLE alone on the RCOG VTE risk assessment model.

Ethics Approval

This study received IRB approval from the relevant NYU Langone Health IRB committee responsible for human experimentation. Reference number i14–00487, approved July 27, 2021.

Publication History

Received: 17 May 2023

Accepted: 09 June 2023

Article published online:
20 July 2023

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