How do we manage venous thromboembolism in pregnancy? A retrospective review of the practice of diagnosing and managing pregnancy-related venous thromboembolism at two major hospitals in Australia and New Zealand
Article first published online: 10 OCT 2012
© 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 42, Issue 10, pages 1104–1112, October 2012
How to Cite
Chan, N., Merriman, E., Hyder, S., Woulfe, T., Tran, H. and Chunilal, S. (2012), How do we manage venous thromboembolism in pregnancy? A retrospective review of the practice of diagnosing and managing pregnancy-related venous thromboembolism at two major hospitals in Australia and New Zealand. Internal Medicine Journal, 42: 1104–1112. doi: 10.1111/j.1445-5994.2012.02863.x
Conflict of interest: None.
- Issue published online: 10 OCT 2012
- Article first published online: 10 OCT 2012
- Accepted manuscript online: 4 JUL 2012 02:15AM EST
- Manuscript Accepted: 31 MAY 2012
- Manuscript Received: 7 NOV 2011
- venous thromboembolism;
- pregnancy complication;
- post-partum haemorrhage;
- pregnancy outcome
North American and European literature suggest that the incidence rate for pregnancy-related thromboembolism (VTE) ranges from 0.5 to 2 per 1000 pregnancies. However, there is a paucity of data regarding pregnancy-related VTE in Australia and New Zealand.
To define the epidemiology, management and adverse effects of pregnancy-related VTE in Australia and New Zealand.
Retrospective chart review of pregnant patients with objectively diagnosed pregnancy-related VTE at Monash Medical Centre and the North Shore Hospital from January 2007 to March 2011.
Sixty women with VTE were identified, 31 and 29 in the antepartum and post-partum period respectively. VTE occurred as early as 8 weeks of gestation. There was a trend towards higher proportion of PE in the postpartum period. Most antenatal patients were started on enoxaparin and dosed according to weight at diagnosis. A wide variability in maintenance dosing strategies was observed. Three (5%, 95% CI: 1% to 14%) patients suffered major bleeds, all occurring post-partum. Recurrences occurred in two post-partum patients who received a truncated course of enoxaparin for distal deep-vein thrombosis. Although more women had an induction of labour, this did not translate into an increased Caesarean section rate.
The epidemiology of pregnancy-related VTE is similar to that of other developed countries. All three bleeding events occurred in the immediate post-partum setting, highlighting the need for caution at this critical time. VTE recurrences occurred in those women with post-partum distal deep-vein thrombosis treated with an abbreviated course of enoxaparin.