CC-BY 4.0 · TH Open 2018; 02(02): e116-e130
DOI: 10.1055/s-0038-1635573
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Risk Assessment and Management of Venous Thromboembolism in Women during Pregnancy and Puerperium (SAVE): An International, Cross-sectional Study

Jean-Christophe Gris
1  Department of Haematology, University of Montpellier and University Hospital of Nîmes, France
,
Joseph Aoun
2  Sanofi International Region, Antony, France
,
Leyla Rzaguliyeva
3  Republican Clinical Hospital, Baku, Azerbaijan
,
Rowshan Begum
4  Holy Family Red Crescent Medical College and Hospital, Dhaka, Bangladesh
,
Hassan Salah
5  Department of Gynecology and Obstetrics, Assiut University, Assiut, Egypt
,
Tatia Tugushi
6  Reproductive Health Center “Fertimed,” Tbilisi, Georgia
,
Mohammed Ghani-Chabouk
7  Salman Faeq Center, Baghdad, Iraq
,
Mazen Zibdeh
8  Department of Obstetrics and Gynaecology, Gardens Hospital, Amman, Jordan
,
Waleed Al Jassar
9  Maternity Hospital, Kuwait, Kuwait
,
Joe Abboud
10  Hotel Dieu de France Hospital, Beirut, Lebanon
,
Nadia Meziane
11  Oum Albanine Clinic, Casablanca, Morocco
,
Godwin-Olufemi Ajayi
12  Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
,
Nazli Hossain
13  Department of Obstetrics and Gynecology, Dow University of Health Sciences, Karachi, Pakistan
,
Alexey Pyregov
14  Scientific Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia
,
Hassan Abduljabbar
15  King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
,
Leon C. Snyman
16  Department of Obstetrics and Gynaecology, University of Pretoria and Kalafong Provincial Tertiary Hospital, Pretoria, South Africa
,
Radhouane Rachdi
17  Gynecology and Obstetrics, Military Hospital, Tunis, Tunisia
,
Muna-Abdulrazzaq Tahlak
18  Department of Gynecology-Obstetrics, Latifa Hospital, Al Jaddaf, Dubai, United Arab Emirates
,
Dilbar Najmutdinova
19  Republican Specialized Scientific Practical Medical Center of Obstetrics and Gynecology, Tashkent, Uzbekistan
,
the SAVE Study Group› Author Affiliations
Funding Sanofi funded the study, and contributed to the elaboration of the study design and to the analysis. Sanofi author J.A. reviewed and approved the manuscript. J-C.G. and J.A. had full access to the data and the final responsibility for the decision to submit for publication.
Further Information

Publication History

14 September 2017

07 February 2018

Publication Date:
04 April 2018 (online)

Abstract

The clinical burden of obstetric venous thromboembolism (VTE) risk is inadequately established. This study assessed the prevalence and management of VTE risk during pregnancy and postpartum outside the Western world. This international, noninterventional study enrolled adult women with objectively confirmed pregnancy attending prenatal care/obstetric centers across 18 countries in Africa, Eurasia, Middle-East, and South Asia. Evaluations included proportions of at-risk women, prophylaxis as per international guidelines, prophylaxis type, factors determining prophylaxis, and physicians' awareness about VTE risk management guidelines and its impact on treatment decision. Data were analyzed globally and regionally. Physicians (N = 181) screened 4,978 women, and 4,010 were eligible. Of these, 51.4% were at risk (Eurasia, 90%; South Asia, 19.9%), mostly mild in intensity; >90% received prophylaxis as per the guidelines (except South Asia, 77%). Women in Eurasia and South Asia received both pharmacological and mechanical prophylaxes (>55%), while pharmacological prophylaxis (>50%) predominated in Africa and the Middle-East. Low-molecular-weight heparin was the pharmacological agent of choice. Prophylaxis decision was influenced by ethnicity, assisted reproductive techniques, caesarean section, and persistent moderate/high titer of anticardiolipin antibodies, though variable across regions. Prophylaxis decision in at-risk women was similar, irrespective of physicians' awareness of guidelines (except South Asia). A majority (>80%) of the physicians claimed to follow the guidelines. More than 50% of women during pregnancy and postpartum were at risk of VTE, and >90% received prophylaxis as per the guidelines. Physicians are generally aware of VTE risk and comply with guidelines while prescribing prophylaxis, although regional variations necessitate efforts to improve implementation of the guidelines.

Authors' Contributions

J-C.G. and J.A. designed the study and participated in writing the manuscript. All coauthors and study group members read and revised the draft, and approved the final submitted version.


* Members of the SAVE Study Group are listed in the Appendix.


Supplementary Material