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Thromb Haemost 1997; 78(04): 1183-1188
DOI: 10.1055/s-0038-1657712
Rapid Communication
Schattauer GmbH Stuttgart

Risk Factors for Pregnancy Associated Venous Thromboembolism

Mark D McColl
1   The Department of Haematology, Royal Infirmary, Glasgow, UK
,
Jane E Ramsay
2   The Glasgow Royal Maternity Hospital, Glasgow, UK
,
R C Tait
3   The Southern General NHS Trust, Glasgow, UK
,
Isobel D Walker
1   The Department of Haematology, Royal Infirmary, Glasgow, UK
,
Frances McCall
1   The Department of Haematology, Royal Infirmary, Glasgow, UK
,
J A Conkie
1   The Department of Haematology, Royal Infirmary, Glasgow, UK
,
M J Carty
3   The Southern General NHS Trust, Glasgow, UK
,
I A Greer
2   The Glasgow Royal Maternity Hospital, Glasgow, UK
› Author Affiliations
Further Information

Publication History

Received 04 1997

Accepted after resubmission 23 June 1997

Publication Date:
12 July 2018 (online)

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Summary

In an attempt to reduce the incidence of pregnancy associated venous thromboembolism (PA-VTE), some researchers have advocated screening of all women for the factor VLeiden mutation during early pregnancy. We have conducted a large retrospective study (over 72,000 deliveries) to determine if this would be useful. Sixty-two objectively confirmed venous thrombotic events (51 DVT, 11 PE) were recorded at two maternity units in the UK. The incidence of DVT was 0.71 per 1000 deliveries (95% CI 0.5-0.9) with 0.50 occurring in the antenatal period (95% CI 0.34-0.66) and 0.21 in the puerperium (95% CI 0.11-0.31). The incidence of PE was 0.15 per 1000 deliveries (95% CI 0.06-0.24), 0.07 antenatal (95% CI 0.01-0.13) and 0.08 in the puerperium (95% CI 0.02-0.14). Of these 62,50 attended for follow-up and thrombophilia screening. 28% of all episodes of PA-VTE had no CIinical risk factor for thrombosis or an identifiable thrombophilic abnormality. Deficiency of antithrombin was identified in 12% of individuals (95% CI 3-21) and the factor VLeiden mutation in 8% (95% CI 0.5-15.5). Based on estimates of the prevalence of the factor VLeiden mutation in the population, we estimate that the thrombotic risk for a woman during pregnancy or the puerperium with the defect is approximately 1 in 400-500. This figure would not lend support to the idea of random screening for the mutation in early pregnancy.

 

  • References

  • 1 Department of Health. Report on confidential enquiries into maternal death in the United Kingdom 1988-90. HMSO; London: 1994
    Google Scholar
  • 2 Letsky EA, De SwietM. Thromboembolism in Pregnancy and Its Management. Br J Haematol 1984; 57: 543-552
    CrossrefPubMedGoogle Scholar
  • 3 Toglia MR, Weg JG. Thromboembolism During Pregnancy. N Engl J Med 1996; 335: 108-114
    CrossrefPubMedGoogle Scholar
  • 4 Greer IA. Haemostasis and thrombosis in pregnancy. In: Haemostasis and Thrombosis in Pregnancy. Bloom AL, Forbes CD, Thomas DP, Tuddenham EGD. eds. Edinburgh: Churchill Livingstone; 1994. pp 0987-1015
    Google Scholar
  • 5 Hellgren M, Blombäck MM. Studies on blood coagulation and fibrinolysis in pregnancy, during delivery and in the puerperium. Gynaecological and Obstetrical Investigation 1981; 12: 141-154
    PubMedGoogle Scholar
  • 6 The Royal College of Obstetricians and Gynaecologists. Report of the RCOG Working Party on Prophylaxis Against Thromboembolism in Gynaecology and Obstetrics 1995.
    Google Scholar
  • 7 Bertina RM, Koeleman BP, Koster T, Rosendaal FR, Dirven RJ, de RondeH, van derVelden PA, Reitsma PH. Mutationin blood coagulation factor V associated with resistance to activated protein C [see comments]. Nature 1994; 369: 64-67
    CrossrefPubMedGoogle Scholar
  • 8 Bertina RM, Reitsma PH, Rosendaal FR, Vandenbroucke JP. Resistance to activated protein C and factor V Leiden as risk factors for venous thrombosis. Thromb Haemost 1995; 74: 449-453
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Dahlbäck B, Hildebrand B. Inherited resistance to activated protein C is corrected by anticoagulant cofactor activity found to be a property of factor V. Proc Natl Acad Sci USA 1994; 91: 1396-1400
    CrossrefPubMedGoogle Scholar
  • 10 Dahlbäck B. Inherited resistance to activated protein C, a major cause of venous thrombosis, is due to a mutation in the factor V gene. Haemostasis 1994; 24: 139-151
    PubMedGoogle Scholar
  • 11 Dahlbäck B. Factor V gene mutation causing inherited resistance to activated protein C as a basis for venous thromboembolism. Journal of Internal Medicine 1995; 237: 221-227
    CrossrefPubMedGoogle Scholar
  • 12 Dahlbäck B. New molecular insights into the genetics of thrombophilia Resistance to activated protein C caused by Arg 506 to Gin mutation in factor V as a pathogenic risk factor for venous thrombosis. Thromb Haemost 1995; 74: 129-148
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Rees DC, Cox M, Clegg JB. distribution of factor V Leiden [see comments]. Lancet 1995; 346: 1133-1134
    CrossrefPubMedGoogle Scholar
  • 14 Bokarewa MI, Bremme K, Blombäck M. Arg 506-Gln mutation in factor V and risk of thrombosis during pregnancy. Br J Haematol 1996; 92: 473-478
    CrossrefPubMedGoogle Scholar
  • 15 Hellgren M, Svensson PJ, Dahlbäck B. Resistance to activated protein C as a basis for venous thromboembolism associated with pregnancy and oral contraceptives. Am J Obst Gynecol 1995; 173: 210-213
    CrossrefPubMedGoogle Scholar
  • 16 Ginsberg JS, Harish J. Use of antithrombotic agents during pregnancy. Chest 1995; 108: 305S-11S
    CrossrefPubMedGoogle Scholar
  • 17 Greer IA, De SwietM. Thrombosis prophylaxis in obstetrics and gynaecology. Br J Obst Gynaecol 1993; 100: 37-40
    CrossrefPubMedGoogle Scholar
  • 18 Walker ID, Colvin BT. On behalf of the haemostasis and thrombosis task force. Guidelines on the prevention, investigation and management of thrombosis associated with pregnancy. J Clin Pathol 1993; 16: 489-496
    PubMedGoogle Scholar
  • 19 Macklon N, Greer I. Venous thromboembolic disease in Obstetrics and Gynaecology: The Scottish experience. Scot Med J 1996; 41: 83-86
    PubMedGoogle Scholar
  • 20 De SwietM, Fidler J, Howell R, Letsky E. Thromboembolism in pregnancy. In: Advanced Medicine. Jewell D. ed. Pitman Medical; Tunbridge Wells: 1981. pp 309-317
    Google Scholar
  • 21 Rutherford S, Montoro M, McGehee W, Strong T. Thromboembolic disease associated with pregnancy: an 11-year review. Am J Obstet Gynaecol 1991; 164: 286
    PubMedGoogle Scholar
  • 22 Kierkegaard A. Incidence and diagnosis of deep vein thrombosis associated with pregnancy. Acta Obstetrica et Gynecologica Scandinavica 1983; 62: 239-243
    CrossrefPubMedGoogle Scholar
  • 23 Treffers P, Huidekoper B, Weenink G, Kloosterman G. Epidemiological observations of thromboembolic disease during pregnancy and in the puerperium, in 56,022 women. Inti J Gynaecol Obst 1983; 21: 327-331
    PubMedGoogle Scholar
  • 24 Friederich P, Sanson B, Simioni P, Zanaidi S, Huisman M, Kindt I, Prandoni P, Büller H, Girolami A, Prins M. Frequency of pregnancy-related venous thromboembolism in anticoagulant factor-deficient women: implications for prophylaxis. Annals Int Med 1996; 125: 955-960
    CrossrefPubMedGoogle Scholar
  • 25 Ginsberg JS, Brill-Edwards P, Burrows RF, Bona R, Prandoni P, Buller HR, Lensing A. Venous thrombosis during pregnancy: leg and trimester of presentation. Thromb Haemost 1992; 67: 519-520
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Pabinger I, Schneider B. Thrombotic risk in hereditary antithrombin III, protein C, or protein S deficiency A cooperative, retrospective study. Ge-sellschaft fur Thrombose- und Hämostaseforschung (GTH) Study Group on Natural Inhibitors. Arteriosclerosis, Thrombosis & Vascular Biology 1996; 16: 742-748
    CrossrefPubMedGoogle Scholar
  • 27 Beauchamp NJ, Daly ME, Hampton KK, Cooper PC, Preston FE, Peake IR. prevalence of a mutation in the factor V gene within the U.K. population: relationship to activated protein C resistance and familial thrombosis. Br J Haematol 1994; 88: 219-222
    CrossrefPubMedGoogle Scholar
  • 28 Tait RC, Walker ID, Perry DJ, Islam SI, Daly ME, McCall F, Conkie JA, Carrell RW. Prevalence of antithrombin deficiency in the healthy population. Br J Haematol 1994; 87: 106-112
    CrossrefPubMedGoogle Scholar
  • 29 Tait RC, Walker ID, Reitsma PH, Islam SI, McCall F, Poort SR, Conkie JA, Bertina RM. Prevalence of protein C deficiency in the healthy population. Thromb Haemost 1995; 73: 87-93
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Sanson JS, Friederich PW, Simioni P, Zanardi S, Huisman MV, Girolami A, ten CateJW, Prins MH. The risk of abortion and stillbirth in antithrombin, protein C, and protein S deficient women. Thromb Haemost 1996; 75: 387-388
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Preston F, Rosendaal F, Walker I, Briet E, Bemtorp E, Conard J, Fontcuberta J, Makris M, Mariani G, Noteboom W, Pabinger I, Legnani C, Charrer I, Schulman S, van derMeer F. Increased fetal loss in women with heritable thrombophilia. Lancet 1996; 348: 913-916
    CrossrefPubMedGoogle Scholar
  • 32 Conard J, Horellou MH, Van DredenP, Lecompte T, Samama M. Thrombosis and Pregnancy in Congenital Deficiencies in AT HI, Protein C or Protein S: Study of 78 women. Thromb Haemost 1990; 63: 319-320
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Gandrille S, Greengard JS, Alhenc-Gelas M, Juhan-Vague I, Abgrall JF, Jude B, Griffin JH, Aiach M. Incidence of activated protein C resistance caused by the ARG 506 GLN mutation in factor V in 113 unrelated symptomatic protein C-deficient patients. The French Network on the behalf of INSERM. Blood 1995; 86: 219-224
    PubMedGoogle Scholar
  • 34 Koeleman BP, Reitsma PH, Allaart CF, Bertina RM. Activated protein C resistance as an additional risk factor for thrombosis in protein C-deficient families. Blood 1994; 84: 1031-1035
    PubMedGoogle Scholar
  • 35 Koeleman BP, Van RumptD, Hamulyak K, Reitsma PH, Bertina RM. Factor V Leiden: an additional risk factor for thrombosis in protein S deficient families?. Thromb Haemost 1995; 74: 580-583
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 van BovenHH, Reitsma PH, Rosendaal FR, Bayston TA, Chowdhury V, Bauer KA, Scharrer I, Conard J, Lane DA. Factor V Leiden (FV R506Q) in families with inherited antithrombin deficiency. Thromb Haemost 1996; 75: 417-421
    Article in Thieme ConnectPubMedGoogle Scholar