Clinical characteristics and treatment of maternal venous thromboembolism / 中华围产医学杂志

ABSTRACT

Objective:To analyze the clinical features, treatment, and pregnancy outcomes of women with venous thromboembolism (VTE) during pregnancy and puerperal period.Methods:Clinical data of 81 patients with gestational and puerperal VTE admitted to the Department of Vascular Surgery of Dayi Hospital Affiliated to Shanxi Medical University from January 2014 to December 2017 were retrospectively analyzed. Rank-sum test, t-test or Chi-square test (or Fisher's exact test) were used for statistical analysis. Results:(1) The average age of these women was (30.9±5.2) years old and 20 (24.7%) were ≥35 years old. Pregnant women accounted for 50.6%(41/81). Forty cases were in the puerperium, of which 34 developed VTE within 30 days after delivery. (2) The thrombus was predominantly peripheral type in all subjects after excluding five patients with isolated pulmonary thromboembolism (PTE) (61.8%, 47/76), especially in pregnant patients (80.0%, 32/40), while mixed type was often occurred in the puerperium (44.4%, 16/36, χ2=13.417). The initial symptoms and signs were mainly swelling (43.4%, 33/76) and pain (28.9%, 22/76) with acute onset. Thrombi were mainly found in the deep veins of lower extremities (74.1%, 60/81). More pregnant patients had deep venous thrombosis (DVT) in the lower limbs (87.8%, 36/41), while DVT in the puerperium was often complicated by PTE (30.0%, 12/40, χ2=7.961). Intermuscular veins were the most common affected veins (72.4%, 55/76), especially during pregnancy (85.0%, 34/40), while for those cases during puerperium, multiple veins, such as intermuscular (58.3%, 21/36), femoral (58.3%, 21/36), popliteal (50.0%, 18/36), iliac (47.2%, 17/36), tibial (44.4%, 16/36) and fibular vein (38.8%, 14/36) were involved. (3) The highest risk factor was age ≥35 years old (24.7%, 20/81), followed by antithrombin deficiency (23.5%, 19/81) and hypertensive disorders of pregnancy (HDP, 21.0%, 17/81). There were no significant differences in the distribution of different risk factors between patients during pregnancy and puerperium. D-dimer levels were higher in puerperal patients than in pregnant women [1 029 (639-1 778) vs 619 (355-1 117) μg/L, Z=-3.336, P<0.001]. (4) All patients received systemic anticoagulant therapy. Twenty-four patients (29.6%, including five in pregnancy and 19 in puerperium) were treated with thrombolytic therapy due to extensive thrombus formation. The average hospital stay was (7.3±2.1) d. (5) Among the 41 patients developing VTE during pregnancy, nine (21.9%) received induced labor; 26 (63.4%) underwent cesarean section; six (14.6%) delivered vaginally. Among the 32 pregnancies continuing to deliver, eight (25.0%) premature infants and one (3.1%) macrosomia were born. Conclusions:Maternal VTE mainly occurs in the third trimester or within 30 days after birth. VTE in the puerperal period commonly involves multiple veins and is characterized by extensive thrombus formation. Pregnant women aged ≥35 years, with antithrombin deficiency or complicated with HDP, should be closely observed to prevent VTE as it may affect pregnancy outcomes.