Venous thromboembolism risk score during hospitalization in pregnancy: results of 10694 prospective evaluations in a clinical trial

• Published in: Clinics (São Paulo, Brazil) Vol. 78; p. 100230
• Main Authors: de Barros, Venina Isabel Poço Viana Leme, Igai, Ana Maria Kondo, Baptista, Fernanda Spadotto, Bortolotto, Maria Rita de Figueiredo Lemos, Peres, Stela Verzinhasse, Francisco, Rossana Pulcinelli Vieira
• Format: Journal Article
• Language: English
• Published: United States Elsevier España, S.L.U 01-01-2023; Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo; Faculdade de Medicina / USP
• Subjects: Adult; Anticoagulants - therapeutic use; Female; Hospitalization; Hospitals; Humans; Maternal death; MEDICINE, GENERAL & INTERNAL; Neoplasms; Neoplasms - drug therapy; Original; Pregnancy; Risk Factors; Venous thromboembolism; Venous Thromboembolism - prevention & control; c-section; RR; PR; PS; OR; APS; PROM; VTE; Risk factors; Neoplasms; Maternal death; Pregnancy; LMWH; Hospitals; PE; TPX; Venous thromboembolism; BMI
• ISSN: 1807-5932; 1980-5322; 1980-5322
• DOI: 10.1016/j.clinsp.2023.100230

Hospitalization during pregnancy and childbirth increases the risk of Venous Thromboembolism Risk (VTE). This study applied a VTE risk score to all hospitalized pregnant women to ascertain its effectiveness in preventing maternal death from VTE until 3 months after discharge.
In this interventional study, patients were classified as low- or high-risk according to the VTE risk score (Clinics Hospital risk score). High-risk patients (score ≥ 3) were scheduled for pharmacological Thromboprophylaxis (TPX). Interaction analysis of the main risk factors was performed using Odds Ratio (OR) and Poisson regression with robust variance.
The data of 10694 cases (7212 patients) were analyzed; 1626 (15.2%, 1000 patients) and 9068 (84.8%, 6212 patients) cases were classified as high-risk (score ≥ 3) and low-risk (score < 3), respectively. The main risk factors (Odds Ratio, 95% Confidence Interval) for VTE were age ≥ 35 and < 40 years (1.6, 1.4–1.8), parity ≥ 3 (3.5, 3.0–4.0), age ≥ 40 years (4.8, 4.1–5.6), multiple pregnancies (2.1, 1.7–2.5), BMI ≥ 40 kg/m2 (5.1, 4.3–6.0), severe infection (4.1, 3.3–5.1), and cancer (12.3, 8.8–17.2). There were 10 cases of VTE: 7/1636 (0.4%) and 3/9068 (0.03%) in the high- and low-risk groups, respectively. No patient died of VTE. The intervention reduced the VTE risk by 87%; the number needed to treat was 3.
This VTE risk score was effective in preventing maternal deaths from VTE, with a low indication for TPX. Maternal age, multiparity, obesity, severe infections, multiple pregnancies, and cancer were the main risk factors for VTE.