АССОЦИАЦИЯ ФЛЕБОЛОГОВ РОССИИ

Abstract

OBJECTIVE: : To determine, from the literature, the risk of venous thromboembolism during the postpartum period.

DATA SOURCES: : We searched PubMed and Cochrane Library databases for all articles (in all languages) published in peer-reviewed journals from database inception through May 2010 for evidence related to incidence of venous thromboembolism in postpartum women.

METHODS OF STUDY SELECTION: : We included studies reporting relative risk, incidence rate, or cumulative incidence of venous thromboembolism in postpartum women.

TABULATION, INTEGRATION, AND RESULTS: : We included 15 articles reporting findings from 13 studies. Two studies directly comparing venous thromboembolism during the first 6 weeks postpartum to nonpregnant, nonpostpartum women reported relative effect measures of 21.5 (rate ratio; 95% confidence interval [CI] unable to be calculated) and 84 (odds ratio; 95% CI 31.7-222.6), respectively. A third study reported relative effect measures for deep venous thrombosis (15.2, 95% CI 13.2-17.6; standardized incidence ratio) and pulmonary embolism (9.2, 95% CI 6.5-12.7) separately. Three studies reported incidence rates of venous thromboembolism during the postpartum period (range 25-99 per 10,000 woman-years). We compared these incidence rates to baseline rates among nonpregnant, nonpostpartum women reported in the literature to generate rate ratios; these rate ratios ranged from 2.5 to 21.5. Nine studies reported cumulative incidence proportions of postpartum venous thromboembolism, ranging from 0.14 to 3.24 per 1,000 deliveries at 6 weeks postpartum. Incidence of venous thromboembolism was highest immediately after delivery (standardized incidence ratio for deep venous thrombosis 115.1 [95% CI 96.4-137.0], and for pulmonary embolism 80.7 [95% CI 53.9-117.9]); between 4 and 6 weeks postpartum, risk declined but was still approximately five-times to seven-times that of nonpregnant, nonpostpartum women.

CONCLUSION: : During the first 6 weeks postpartum, women's risk of venous thromboembolism increased 21.5-fold to 84-fold from baseline in nonpregnant, nonpostpartum women in studies that included an internal reference group. Although incidence of venous thromboembolism declined quickly after delivery, when this risk returns to baseline is not clear from current data.

Eur J Vasc Endovasc Surg. 2012 Jan 18. [Epub ahead of print]
Superficial Vein Thrombosis in Patients with Varicose Veins: Role of Thrombophilia Factors, Age and Body Mass.
Karathanos C, Sfyroeras G, Drakou A, Roussas N, Exarchou M, Kyriakou D, Giannoukas AD.
Source
Department of Vascular Surgery, University Hospital of Larissa, University of Thessalia, Larissa 41 110, Greece.
Abstract
OBJECTIVES:
To investigate the association of various risk factors including thrombophilia defects, in patients with varicose veins (VVs) and history of episodes of superficial vein thrombosis (SVT).
MATERIALS AND METHODS:
Two hundred and thirty patients with primary VVs were included in this prospective study. A total of 128 (43 men, age 56 ± 13) had an acute episode or a previous history of SVT, while 102 patients (27 men, age 48 ± 12) did not. Coagulation profile investigation included serum levels of protein C (PC), protein S (PS), anti-thrombin III (AT III), plasminogen (Plg), A(2) antiplasmin (A(2)Apl) and activated protein C resistance (APCR). This was performed at least 3 months after the SVT episode to ensure that the results were not altered. Age and body mass index (BMI) were also assessed.
RESULTS:
PC deficiency was detected in 3/128 (2.3%), PS deficiency in 19/128 (14.8%), AT III deficiency in 29/128 (22.7%), Plg deficiency in 9/128 (7%), A(2)Apl excess in 3/128 (2.3%) and APCR in 9/128 (7%) patients with SVT and 0/102 (0%), 3/102 (2.9%), 15/102 (14.7%), 6/102 (5.8%), 0/102 (0%) and 1/102 (0.9%) in the control group, respectively. BMI greater than 30 kg m(-2) was associated with SVT. In logistic regression analysis SVT was associated with PS deficiency (odds ratio (OR) 6.7, p = 0.004, 95% confidence interval (CI) 1.83-24.53), obesity (OR 3.5, p = 0.003, 95% CI 1.53-8.05) and age (OR 1.038, p = 0.001, 95% CI 1.01-1.06).
CONCLUSIONS:
Obesity, age and PS deficiency were found as factors associated with SVT episodes in patients with VVs.