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Previous Volume 343:1439-1444 November 16, 2000 Number 20 Next

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ABSTRACT

Background Women with a history of venous thromboembolism may be at increased risk for venous thromboembolic events during pregnancy. In these women, the decision to give or withhold heparin in the antepartum period is controversial, because accurate estimates of the frequency of recurrent thromboembolic events if antepartum heparin is withheld are not available.

Methods We prospectively studied 125 pregnant women with a single previous episode of venous thromboembolism. Antepartum heparin was withheld, but anticoagulant therapy was given for four to six weeks post partum. Our primary objective was to determine the rate of antepartum recurrence of venous thromboembolism. Laboratory studies were performed to identify thrombophilia in 95 women.

Results Three of the 125 women (2.4 percent) had an antepartum recurrence of venous thromboembolism (95 percent confidence interval, 0.2 to 6.9 percent). There were no recurrences in the 44 women who had no evidence of thrombophilia and who also had a previous episode of thrombosis that was associated with a temporary risk factor. Among the 51 women with abnormal laboratory results or a previous episode of idiopathic thrombosis, or both, 3 (5.9 percent) had an antepartum recurrence of venous thromboembolism (95 percent confidence interval, 1.2 to 16.2 percent).

Conclusions The risk of recurrent antepartum venous thromboembolism in women with a history of venous thromboembolism is low, and therefore routine antepartum prophylaxis with heparin is not warranted.

Source Information

From the McMaster University Medical Centre, Hamilton, Ont. (P.B.-E., J.S.G., M.G., J.H., C.K., J.I.W.); Monash Medical Centre, Clayton, Vic., Australia (R.B.); Sunnybrook Health Science Centre, Toronto (W.G.); London Health Science Centre, London, Ont. (M.K.); Queen Elizabeth II Health Science Centre, Halifax, N.S. (K.S.R.); Hôpital du Sacré-Coeur de Montréal, Montreal (R.W.); and the Centre Hospitalier de l'Université du Québec–St. François d'Assise, Quebec, Que. (G.C.) — all in Canada.

Address reprint requests to Dr. Ginsberg at the McMaster University Medical Centre, 1200 Main St. W, HSC-3X28, Hamilton, ON L8N 3Z5, Canada, or at ginsbrgj{at}fhs.mcmaster.ca.

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