Thromb Haemost 2023; 123(11): 1060-1068
DOI: 10.1055/s-0043-1769592
Stroke, Systemic or Venous Thromboembolism

Venous Thromboembolism in Women of Childbearing Age: Insights from the START Registry

1   Thrombosis and Haemostasis Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Italy
2   Ob/Gyn Department, University of Foggia, Foggia, Italy
3   Ob/Gyn and Perinatal Medicine Department of The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
Emilia Antonucci
4   Fondazione Arianna Anticoagulazione, Bologna, Italy
Donatella Colaizzo
1   Thrombosis and Haemostasis Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Italy
Antonio De Laurenzo
1   Thrombosis and Haemostasis Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Italy
Benilde Cosmi
5   UO di Angiologia e Malattie della Coagulazione, Dipartimento Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna; Azienda Ospedaliero Universitaria S. Orsola-Malpighi, IRCCS, Bologna, Italy
Michela Cini
4   Fondazione Arianna Anticoagulazione, Bologna, Italy
Cristina Legnani
4   Fondazione Arianna Anticoagulazione, Bologna, Italy
Sophie Testa
6   Centro Emostasi e Trombosi, UUOO Laboratorio Analisi chimico-cliniche e microbiologiche, ASST Cremona, Cremona, Italy
Maurizio Margaglione
7   Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
Gualtiero Palareti
4   Fondazione Arianna Anticoagulazione, Bologna, Italy
› Author Affiliations
Funding The Arianna Anticoagulation Foundation promotes and supports the START registry, including the present study. The authors do not disclose receipt of the financial support for the research, authorship, and/or publication of this article.


Background Women of childbearing age are exposed to venous thromboembolic risk mainly for pregnancy and use of oral contraceptives. The impact of risk factors (RF) on venous thromboembolism (VTE) in these circumstances is still unclear.

Aim In the context of START registry, we aimed to investigate the weight of a series of RF on the occurrence of pregnancy- or combined oral contraceptive (COC)-associated VTE.

Materials and Methods We selected all women included in the START for VTE occurred between 18–42 years and compared those with a first or recurrent pregnancy/postpartum- (group A) or COC-VTE (group B) with those who had VTE outside these circumstances (group C). Final analysis included a cohort of 532 women. Follow-up data showed that there were no significant differences between the groups in terms of thrombotic and haemorrhagic complications. As for pregnancy-associated VTE, the overall outcome was good in terms of both maternal and fetal prognosis.

Results In a binary model of logistic regression, correcting for potential confounders, VTE family history conferred a significant and independent higher risk of COC-VTE compared with group C. Similarly, comparison between group A and C documented that family history significantly affected the risk of pregnancy-associated VTE. VTE in the group C was significantly associated with older age. Lastly, smoke was a significant risk factor for pregnancy/postpartum VTE when group A and group B were compared.

Conclusion Present data suggest that in the setting of fertile women, family history of VTE has a greater role in predicting COC- and pregnancy/postpartum- VTE than outside these circumstances.


The list of START Registry Investigators is available in the [Supplementary Material] (available in the online version).

Supplementary Material

Publication History

Received: 27 February 2023

Accepted: 25 April 2023

Article published online:
01 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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