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CC BY 4.0 · TH Open 2021; 05(01): e24-e34
DOI: 10.1055/s-0040-1722611
Original Article

Pregnancy-Associated Venous Thromboembolism: Insights from GARFIELD-VTE

Carlos Jerjes-Sánchez
1   Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud, Instituto de Cardiologia y Medicina Vascular, TecSalud, Monterrey, Mexico
,
David Rodriguez
1   Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud, Instituto de Cardiologia y Medicina Vascular, TecSalud, Monterrey, Mexico
,
Alfredo E. Farjat
2   Thrombosis Research Institute, London, United Kingdom
,
Gloria Kayani
2   Thrombosis Research Institute, London, United Kingdom
,
Peter MacCallum
2   Thrombosis Research Institute, London, United Kingdom
3   Queen Mary University of London, London, United Kingdom
,
Renato D. Lopes
4   Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina, United States
,
Alexander G.G. Turpie
5   McMaster University, Hamilton, Ontario, Canada
,
Jeffrey I. Weitz
5   McMaster University, Hamilton, Ontario, Canada
6   Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
,
Sylvia Haas
7   Formerly Technical University of Munich, Munich, Germany
,
Walter Ageno
8   Department of Medicine and Surgery, University of Insubria, Varese, Italy
,
Shinya Goto 
9   Department of Medicine (Cardiology), Tokai University School of Medicine, Tokai, Japan
,
Samuel Z. Goldhaber
10   Harvard Medical School, Boston, United States
,
Pantep Angchaisuksiri
11   Department of Medicine, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand
,
Joern Dalsgaard Nielsen
12   Copenhagen University Hospital, Copenhagen, Denmark
,
Sebastian Schellong
13   Medical Department, Municipal Hospital, Dresden, Germany
,
Henri Bounameaux
14   Faculty of Medicine, University of Geneva, Geneva, Switzerland
,
Lorenzo G. Mantovani
15   IRCCS Multimedica Milan, Milan, Italy
16   University of Milano, Bicocca, Milan, Italy
,
Paolo Prandoni
17   Arianna Foundation on Anticoagulation, Bologna, Italy
,
Ajay K. Kakkar
18   University College London, London, United Kingdom
,
on behalf of the GARFIELD-VTE investigators › Author Affiliations Funding The GARFIELD-VTE Registry is an independent academic research initiative sponsored by the Thrombosis Research Institute (London, UK) and supported by an unrestricted research grant from Bayer Pharma AG (Berlin, Germany).
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Abstract

Introduction The risk of venous thromboembolism (VTE) increases during pregnancy and the puerperium such that VTE is a leading cause of maternal mortality.

Methods We describe the clinical characteristics, diagnostic strategies, treatment patterns, and outcomes of women with pregnancy-associated VTE (PA-VTE) enrolled in the Global Anticoagulant Registry in the FIELD (GARFIELD)-VTE. Women of childbearing age (<45 years) were stratified into those with PA-VTE (n = 183), which included pregnant patients and those within the puerperium, and those with nonpregnancy associated VTE (NPA-VTE; n = 1,187). Patients with PA-VTE were not stratified based upon the stage of pregnancy or puerperium.

Results Women with PA-VTE were younger (30.5 vs. 34.8 years), less likely to have pulmonary embolism (PE) (19.7 vs. 32.3%) and more likely to have left-sided deep vein thrombosis (DVT) (73.9 vs. 54.8%) compared with those with NPA-VTE. The most common risk factors in PA-VTE patients were hospitalization (10.4%), previous surgery (10.4%), and family history of VTE (9.3%). DVT was typically diagnosed by compression ultrasonography (98.7%) and PE by chest computed tomography (75.0%). PA-VTE patients more often received parenteral (43.2 vs. 15.1%) or vitamin K antagonists (VKA) (9.3 vs. 7.6%) therapy alone. NPA-VTE patients more often received a DOAC alone (30.2 vs. 13.7%). The risk (hazard ratio [95% confidence interval]) of all-cause mortality (0.59 [0.18–1.98]), recurrent VTE (0.82 [0.34–1.94]), and major bleeding (1.13 [0.33–3.90]) were comparable between PA-VTE and NPA-VTE patients. Uterine bleeding was the most common complication in both groups.

Conclusion VKAs or DOACs are widely used for treatment of PA-VTE despite limited evidence for their use in this population. Rates of clinical outcomes were comparable between groups.

Keywords

venous thromboembolism - registry - deep vein thrombosis - pulmonary embolism - pregnancy

Note

Independent ethics committee and hospital-based institutional review board approvals were obtained, as necessary, for the registry protocol. Patient consent has also been obtained. The lead authors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported, that no important aspects of the study have been omitted.


* A full list of investigators is given in the [Supplementary Material].


Supplementary Material



Publication History

Received: 13 November 2020

Accepted: 30 November 2020

Article published online:
27 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
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