Personalized thromboprophylaxis using a risk score for the management of pregnancies with high risk of thrombosis: a prospective clinical study
Open accessAbstract
Essentials Pregnancy is a risk factor for thrombosis. Management of thrombosis risk in pregnancy remains a challenge. Prophylaxis needs to be personalized. Our score may be a helpful tool for the management of pregnancies at high risk of thrombosis.Summary Background Patients with thrombophilia and/or a history of venous thromboembolism (VTE) are at risk of thrombosis during pregnancy. A risk score for pregnancies with an increased risk of VTE was previously described by our group (Lyon VTE score). Objectives The aim of this prospective study was to assess the efficacy and safety of our score-based prophylaxis strategy in 542 pregnancies managed between 2005 and 2015 in Lyon University Hospitals. Patients/Methods Of 445 patients included in the study, 36 had several pregnancies during the study period. Among these 445 patients, 279 had a personal history of VTE (62.7%), 299 patients (67.2%) had a thrombophilia marker, and 131 (29.4%) thrombophilic women had a personal history of VTE. During pregnancy, patients were assigned to one of three prophylaxis strategies according to the risk scoring system. Results In the antepartum period, low molecular weight heparin (LMWH) prophylaxis was prescribed to 64.5% of patients at high risk of VTE. Among them, 34.4% were treated in the third trimester only, and 30.1% were treated throughout pregnancy. During the postpartum period, all patients received LMWH for at least 6 weeks. Two antepartum-related VTEs (0.37%; one with a score of < 3 and the other with a score of > 6) and four postpartum-related VTEs (0.73%; three with scores of 3-5 and one with a score of > 6) occurred. No case of pulmonary embolism was observed during the study period. The rate of bleeding was 0.37%. No serious bleeding requiring transfusions or surgery occurred during the study period. Conclusion The use of a risk score may provide a rational decision process to implement safe and effective antepartum thromboprophylaxis in pregnant women at high risk of VTE.
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Bed rest of more than 18 hours per day was considered a risk factor for VTE and was given a score of 2 out of a possible score of 6 points.
“Bed rest of more than 18 hours per day was considered a risk factor for VTE and was given a score of 2 out of a possible score of 6 points.”
From Society for Maternal-Fetal Medicine Consult Series #50: The role of activity restriction in obstetric management (2020) · cites this paper as [37]
The Lyon VTE score section defines bed rest as lying in bed for more than 18 hours per day, and Table 1 assigns bed rest or immobilization 2 points. But 6 is not the maximum possible total score: the paper reports patients with scores greater than 6. (LLM, conf=0.91)
Experimental — accuracy not yet measuredDargaud et al devised a risk scoring system for evaluating pregnant women at risk of thrombosis.
“Dargaud et al37 devised a risk scoring system for evaluating pregnant women at risk of thrombosis.”
From Society for Maternal-Fetal Medicine Consult Series #50: The role of activity restriction in obstetric management (2020) · cites this paper as [37]
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References 32 · Cited by 44
Research works printed but not linked: 1
- Guerby P, Vidal F, Garoby-Salom S, Vayssiere C, Salvayre R, Parant O, Negre-Salvayre A. Oxidative stress and preeclampsia: a review. Gynecol Obstet Fertil 2015; 43: 751-6.
- Authors
- Dargaud, Y., Rugeri, L., Fleury, C., Battie, C., Gaucherand, P., Huissoud, C., Rudigoz, R. C., Desmurs‐Clavel, H., Ninet, J., & Trzeciak, M. C.
- Affiliations
- Hôpital Louis Pradel (FR)
- Hôpital Edouard Herriot (FR)
- Hôpital Femme Mère Enfant (FR)
- Hôpital de la Croix-Rousse (FR)
- Corresponding author
- Dargaud, Y.
- Venue
- Journal of Thrombosis and Haemostasis
- Publisher
- Elsevier BV
- Published
- 2017-05
- Volume
- 15
- Issue
- 5
- Pages
- 897-906
- ISSN
- 1538-7836 (ISSN-L)
- OpenAlex
- W2590099884
- Cited by
- 44
- References
- 32
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 8 · 2021: 7 · 2020: 7 · 2019: 4 · 2018: 3 · 2017: 2
- FWCI
- 4.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thrombosis and Haemostasis (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- thromboprophylaxis, pregnancy, venous thromboembolism, thrombophilia, risk score, low molecular weight heparin, postpartum thrombosis, personalized prophylaxis, thromboprophylaxis duration
- MeSH terms
- Clinical Decision-Making, Adult, Anticoagulants, Blood Coagulation, Decision Support Techniques, Female, France, Hemorrhage, Heparin, Low-Molecular-Weight, Hospitals, University, Humans, Predictive Value of Tests, Pregnancy, Pregnancy Complications, Hematologic, Prospective Studies, Risk Factors, Treatment Outcome, Risk Assessment, Venous Thromboembolism
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