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Thromb Haemost 2012; 108(06): 1165-1171
DOI: 10.1160/TH12-05-0350
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Differential haemostatic risk factors for pregnancy-related deep-vein thrombosis and pulmonary embolism

A population-based case-control study
Astrid Bergrem
1   Departement of Haematology, Oslo University Hospital, Oslo, Norway
2   Research Institute of Internal Medicine, Oslo, Norway
3   University of Oslo, Institute of Clinical Medicine, Oslo, Norway
,
Anders E. A. Dahm
1   Departement of Haematology, Oslo University Hospital, Oslo, Norway
2   Research Institute of Internal Medicine, Oslo, Norway
,
Anne Flem Jacobsen
4   Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
,
Leiv Sandvik
5   Clinical Research, Oslo University Hospital, Oslo, Norway
,
Per Morten Sandset
1   Departement of Haematology, Oslo University Hospital, Oslo, Norway
2   Research Institute of Internal Medicine, Oslo, Norway
3   University of Oslo, Institute of Clinical Medicine, Oslo, Norway
› Author Affiliations Financial support:AB is a research fellow with the University of Oslo. The study was supported by grants from the southeastern Norway Health Authority, the Oslo University Hospital Trust, and the Norwegian Research Council (grant no 160805-V50). The sponsors of the study had no role in the study design;the collection, analysis, and interpretation of data;or writing, review, or approval of the manuscript. The authors are fully independent of the sponsors.
Further Information

Publication History

Received: 25 May 2012

Accepted after minor revision: 07 September 2012

Publication Date:
30 November 2017 (online)

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Summary

Limited data exist on thrombophilia and the risk of venous thrombosis (VT) during pregnancy and postpartum. The objectives of the present study were to investigate the role of haemostatic risk factors for pregnancy-related VT and their phenotypic expression in deep-vein thrombosis (DVT) and pulmonary embolism (PE). Total 313 cases with objectively verified first time VT and 353 controls were selected from a source population of 377,155 women with 613,232 pregnancies. The adjusted odds ratio (aOR) for pregnancy-related VT was 1.7 (95% confidence interval [CI] 1.1–2.8) for women with factor VIII >90th percentile. The aOR for VT for endogenous thrombin potential and D-dimer values >90thpercentiles were 1.8 (95% CI 1.1–3.0) and 2.1 (95% CI 1.3–3.3), respectively. Factor IX >90thpercentile or free protein S ≤the 5th percentile increased the risk for PE, and the aORs were 2.4 (95% CI 1.1–5.0) and 3.1 (95% CI 1.3–7.2), respectively. Women carrying the factor V Leiden (F5 rs6025) polymorphism, or who had reduced sensitivity to activated protein C (aPC) in the absence of F5 rs6025, had increased risk for DVT, with unadjusted ORs 7.7 (95% CI 4.7–12.7) and 3.5 (95% CI 2.2–5.4), respectively. Women with a history of pregnancy-related VT showed activation of coagulation and had elevated factor VIII. Furthermore, high levels of factor IX and low levels of free protein S were associated with increased risk for PE, whereas aPC resistance and F5 rs6025 were risk factors for DVT and not PE.

Keywords

Venous thrombosis - deep-vein thrombosis - pulmonary embolism - pregnancy - thrombophilia
 

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