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Thromb Haemost 2008; 100(02): 246-252
DOI: 10.1160/TH08-04-0238
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Recurrent venous thromboembolism after pregnancy-associated versus unprovoked thromboembolism

Richard H.White
1   Department of Internal Medicine
,
Wee-Shian Chan
3   Department of Medicine, University of Toronto, Toronto, Ontario, Canada
,
Hong Zhou
2   Department of Medicine and Statistics, UC Davis, Sacramento, California, USA
,
Jeffrey S. Ginsberg
4   Department of Medicine, McMaster University, Hamilton, Ontario, Canada
› Author AffiliationsFinancial support: Funded by the Hibbard E. Williams Endowment UC Davis School of Medicine, Sacramento, California, USA.
Further Information

Publication History

Received 17 April 2008

Accepted after minor revision 29 May 2008

Publication Date:
22 November 2017 (online)

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Summary

It is not known whether women who develop venous throm-boembolism (VTE) during pregnancy have a higher or lower incidence of recurrent VTE than women with unprovokedVTE. The aim of the study was to compare the risk of recurrent VTE among women with pregnancy-associated VTE to women with unprovoked VTE. Hospital discharge data identified women age 18–46 years old with pregnancy-associated or unprovoked index VTE between 1994 and 2005. Risk of recurrent VTE was compared between six and 60 months after the index event using both age-matched comparison of disease-free survival and proportional hazard modelling, adjusting for age and other risk factors. The Kaplan-Meier incidence of recurrent VTE in 1085 women with pregnancy-associatedVTE was 5.8% versus 10.4% in 7625 women with unprovoked VTE (p=0.02). Twelve of 34 (35%) recurrent events in the pregnancy-associated group occurred during a subsequent pregnancy compared with 29 of 331 (8.7%) events in the unprovoked group (p<0.001).In the risk-adjusted multivariate model, women with pregnancy-associated VTE had a significantly lower risk of recurrent VTE (HR = 0.6, 95%CI=0.4–0.9). Overall, the incidence of recurrentVTE during subsequent pregnancies was higher in the pregnancy group, 21 of 465 (4.5%), than in the unprovoked group, 37 of 1353 (2.7%, RR=1.7, CI:1.0–2.8). Compared to women with unprovoked VTE, women with pregnancy-associated VTE had a significantly lower long-term risk of recurrent VTE but a higher risk of recurrent VTE during a subsequent pregnancy. These findings should be considered when decisions are made about VTE prophylaxis in women with a history of pregnancy-associated VTE.

Keywords

Venous thromboembolism - epidemiology - recurrent - pregnancy - unprovoked
 

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