Thromb Haemost 2018; 118(09): 1564-1571
DOI: 10.1055/s-0038-1668524
Coagulation and Fibrinolysis
Georg Thieme Verlag KG Stuttgart · New York

Benefit of Risk Score-Guided Prophylaxis in Pregnant Women at Risk of Thrombotic Events: A Controlled Before-and-After Implementation Study

Céline Chauleur
1  INSERM U1059, Saint-Etienne, France
2  University of Lyon, Saint-Etienne, France
3  Department of Gynecology and Obstetrics, University Hospital of Saint-Etienne, Saint-Etienne, France
,
Jean-Christophe Gris
4  Department of Hematology, University Hospital of Nîmes, Nîmes, France
5  UPRES EA2990, University of Montpellier, Montpellier, France
,
Silvy Laporte
1  INSERM U1059, Saint-Etienne, France
2  University of Lyon, Saint-Etienne, France
6  Clinical Pharmacology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
,
Céline Chapelle
6  Clinical Pharmacology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
,
Laurent Bertoletti
1  INSERM U1059, Saint-Etienne, France
6  Clinical Pharmacology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
,
Véronique Equy
7  Department of Gynecology and Obstetrics, Grenoble University Hospital, Grenoble, France
,
Pascal Gaucherand
8  Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron Cedex, France
,
Eva Bazan
9  Department of Gynecology and Obstetrics, Montélimar Hospital, Montélimar, France
,
Olivier Dupuis
10  Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre-Bénite, France
,
Denis Gallot
11  Department of Gynecology and Obstetrics, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
,
Patrick Mismetti
1  INSERM U1059, Saint-Etienne, France
2  University of Lyon, Saint-Etienne, France
,
The STRATHEGE Investigators and The STRATHEGE Group› Author Affiliations
Funding This study was sponsored by the University Hospital of Saint Etienne and supported by grants from the French Ministry of Health (Hospital Clinical Research Program PHRC IR 0508080) in 2005 and 2010, and a grant from Bourse LIVE.
Further Information

Publication History

23 November 2017

05 July 2018

Publication Date:
13 August 2018 (eFirst)

Abstract

Background Management of pregnant women at risk of venous thromboembolism (VTE) and placental vascular complications (PVCs) remains complex. Guidelines do not definitively specify optimal strategies.

Objective Our objective was to evaluate the impact of employing risk score-driven prophylaxis strategies on VTE and PVC rates in at-risk pregnant women.

Materials and Methods This study, conducted in 21 French maternity units, compared VTE and PVC rates before and after implementation of a risk scoring system to determine prophylactic strategies.

Results A total of 2,085 pregnant women at risk of VTE or PVC were enrolled. Vascular events occurred in 190 (19.2%) patients before and 140 (13.0%) after implementation of risk score-driven prophylaxis (relative risk [RR] = 0.68 [0.55; 0.83]). The incidence of deep vein thrombosis during pregnancy was reduced (RR = 0.30 [0.14; 0.67]). PVC comprised mainly pre-eclampsia, occurring in 79 patients before and 42 patients after risk score implementation (RR = 0.52 [0.36; 0.75]). Post-partum haemorrhage occurred in 32 patients (3.2%) before and 48 patients (4.5%) after risk score implementation (RR = 1.38 [0.89; 2.13], p = 0.15).

Conclusion Use of a simple risk scoring system, developed by experts in VTE and PVC research to guide prophylaxis, reduced the risk of thrombotic events during pregnancy without any significant increase in bleeding risk.

Authors' Contributions

C. Chauleur: Literature search, study design, data collection, data analysis, data interpretation and writing of the manuscript. J. C. Gris: Data interpretation and writing of the manuscript. S. Laporte, C. Chapelle and L. Bertoletti: Data analysis, data interpretation and writing of the manuscript. V. Equy, P. Gaucheran, E. Bazan, O. Dupuis and D. Gallot: Contributed equally to data collection. P. Mismetti: Study design.


STRATHEGE Investigators and STRATHEGE Group: Contributed equally to study design and data collection.


Members of the STRATHEGE Group

Prof. D. Benhamou: Paris - Kremlin-Bicêtre, Dr. C. Biron-Andreani: Montpellier, Dr. J. Y. Borg: Rouen, Prof. C. Chauleur: Saint-Etienne, Dr. J. Conard: Paris, Dr. E. Demaistre: Dijon, Prof. L. Drouet: Lariboisière, Paris, Dr. P. Edelman: Paris, Prof. J. Emmerich: HEGP, Paris, Prof. P. Gaucherand: Lyon, Prof. J. C. Gris: Nîmes, Prof. Y. Gruel: Tours, Prof. B. Jude: Lille, Dr. J. L. Lorenzini: Dijon, Prof. P. Mismetti: Saint-Etienne, Dr. E. Pasquier: Brest, Prof. G. Pernod: Grenoble, Dr. A. Robert: Saint-Antoine, Paris, Dr. B. Tardy: Saint-Etienne, Dr. N. Trillot: Lille.


Members of the STRATHEGE Investigators

Dr. C. Chauleur, Dr. V. Equy, Dr. P. Gaucherand, Dr. E. Bazan, Dr. O. Dupuis, Dr. D. Gallot, Dr A. Favard, Dr. C. Huissoud, Dr. A. Cornu, Dr. J.F. Nord, Dr. C. Houlle, Dr. F. Ruesch, Dr. E. Magne, Dr. R. Ghawi, Dr. P. Mares, Dr. F. Champion, Dr. A.M. Forest, Dr. P. Boulot, Dr. F. Bousquet, Dr. L. Vulliez, Dr. G. Le Maout.


Ethical Approval

This protocol was approved by the ethics committee of the University Hospital of Saint Etienne on October 19th, 2006; and by the National Commission on Computerization and Freedom (Commission Nationale de l'Informatique et des Libertés [CNIL]): 908179; CTTIRS: 08.120. The study was registered with Clinicaltrials.gov (registry no. NCT0074521).