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Muhamad N, Abu MA, Kalok AH, Shafiee MN, Shah SA, Ismail NAM. Safety and effectiveness of fondaparinux as a postpartum thromboprophylaxis during puerperium among muslim women: A single centre prospective study. Front Pharmacol 2022; 13:887020. [PMID: 36210844 PMCID: PMC9540499 DOI: 10.3389/fphar.2022.887020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Venous thromboembolism (VTE) remains one of the leading causes of maternal morbidity and mortality, with postpartum period carrying the greatest risk. Perinatal thromboprophylaxis is often administered based on risk-factor assessment. Low molecular weight heparin has a proven safety profile in the obstetrics population, however, its porcine-derived content may lead to reduced uptake amongst certain religious groups. We aimed to evaluate the safety of fondaparinux as an alternative postpartum thromboprophylaxis. Methods: We conducted a prospective, single arm, open label study from September 2017 until March 2018. Women who fulfilled the criteria for post natal thromboprophylaxis based on the 2015 RCOG guidelines were recruited. Each patient received subcutaneous injection of Fondaparinux, 2.5 mg daily for 10 days. A telephone interview was conducted on day 10 post delivery. Each woman was subsequently reviewed in the outpatient clinic 6 weeks postpartum. The primary outcome measure was occurrence of pulmonary embolism or deep vein thrombosis suggestive by clinical symptoms and assessment. Secondary outcome measures were allergic reaction and bleeding tendency such as secondary post-partum haemorrhage, spinal site bleeding and wound haematoma. Allergic reaction and bleeding tendency in neonates were also recorded. Results: Sixty women were included in the analysis. There were no VTE cases amongst our cohort. No major bleeding was recorded. Two patients (3.3%) had wound haematoma, one of which occurred 3 weeks post delivery. No adverse effect in neonates was noted. Conclusion: Fondaparinux is a safe alternative thromboprophylaxis for postpartum women.
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Affiliation(s)
- Normaliza Muhamad
- Department of Obstetrics and Gynecology, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Muhammad Azrai Abu
- Department of Obstetrics and Gynecology, UKM Medical Centre, Kuala Lumpur, Malaysia
- *Correspondence: Muhammad Azrai Abu,
| | - Aida Hani Kalok
- Department of Obstetrics and Gynecology, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd Nasir Shafiee
- Department of Obstetrics and Gynecology, UKM Medical Centre, Kuala Lumpur, Malaysia
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Zhou Q, Zhao Z, Xu J, Xiong Y, Li X. Hospital Variation and Associated Organizational Factors of Pregnancy-Related Venous Thromboembolism in China. Clin Appl Thromb Hemost 2022; 28:10760296221076148. [PMID: 35360953 PMCID: PMC8980411 DOI: 10.1177/10760296221076148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective Identifying organizational factors affecting venous thromboembolism (VTE) incidence and variations between hospitals. Methods From a 2019 survey of VTE and live births in 113 hospitals, organizational factors: (hospital type, characteristics, live birth number), resource availability: (D-dimer, B-scan ultrasonography of lower extremity veins, computed tomographic pulmonary angiography [CTPA], and competency: [risk assessment, use of anticoagulants and patient education], data were collected and the associations, weighted by live birth number, analyzed. Results Of 113 hospitals in China, 770,828 live births and 526 cases of VTE (68.2 per 100,000 live births) were reported. Nine hospitals lacked B-scan ultrasonography of lower extremity veins and 22 lacked CTPA. Prevalence rates of VTE rates were higher in general hospitals (Odds ratio [OR] = 4.251, 95% CI: 3.373-5.357), hospitals with live births < 10,000 (OR = 1.650-2.193), and hospitals without B-scan ultrasonography (OR = 1.661, 95% CI: 1.096-2.518). Hospitals implementing patient education, had a lower risk of VTE (OR = 0.296-0.374), and VTE rate decreased with the annual increase in live births. Conclusions Improved hospital resource availability and competency, especially patient education, is vital for reducing VTE-related maternal mortality and morbidity risk.
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Affiliation(s)
- Qiongjie Zhou
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Zhekun Zhao
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jinghui Xu
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yu Xiong
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Xiaotian Li
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
- Institute of Biomedical Sciences, Fudan University, Shanghai, China
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Al-Husban N, Alnsour LN, El-Adwan Z, Saleh NA, El-Zibdeh M. Impact of Pregnancy-Related Venous Thromboembolism on Quality of Patients' Lives. Clin Appl Thromb Hemost 2021; 27:10760296211040873. [PMID: 34747226 PMCID: PMC8573690 DOI: 10.1177/10760296211040873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: During pregnancy, the risk of venous thrombo-embolism (VTE) is increased at least five times compared with non-pregnant women of the same age, while the relative risk in the postpartum period can be as high as sixty times. The aim of the study was to explore the impact of pregnancy-related VTE on patients' mental, professional, social and personal life. Methods and Materials: Cross-sectional study at Jordan University Hospital's Obstetrics Department. Results: There were 112 women. Forty-six (41.1%) had a postpartum VTE. Twenty-eight of the patients (25%) had comorbidity. Eleven (9.9%) had a previous episode of VTE. Thirty-nine (35%) of the women reported three or more hospital visits over the past six months. Twenty-one (19.6%) of the women answered that their leg or chest pain has impeded their social activities. Anxiety/Depression was reported by 96.43% while Pain/Discomfort by 73.21%. A significant reduction of time spent on their work (correlation = 0.663, significant at <0.01) and accomplishing less work (correlation = 0.787, this was significant at <0.01) was found; 57.14% of patients indicated that VTE affecting their future pregnancies; 58.9% of patients were receiving anticoagulants with the most commonly used drug was aspirin. Twenty-four (36.4%) of the women were on multiple anticoagulant therapies. Twenty-five of the patients receiving medications do not monitor their medications and 20 patients said that monitoring the drug level was a bother to them. Conclusions: Pregnancy-related VTE had a significant adverse impact on physical, mental and professional life of women. It also had negative effects on future pregnancy plans.
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Ge YZ, Zhang C, Cai YQ, Huang HF. Application of the RCOG Risk Assessment Model for Evaluating Postpartum Venous Thromboembolism in Chinese Women: A Case-Control Study. Med Sci Monit 2021; 27:e929904. [PMID: 34230447 PMCID: PMC8274362 DOI: 10.12659/msm.929904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Since China has not yet constructed its own risk assessment model (RAM) for pregnancy-related venous thromboembolism (VTE), more and more hospitals use the RCOG RAM for VTE risk prediction. However, the RCOG RAM was established based on Western populations, and its applicability in China is still uncertain. Thus, we aimed to evaluate the validity of the RCOG RAM in predicting postpartum VTE in Chinese maternity. MATERIAL AND METHODS This retrospective case-control study was conducted at the International Peace Maternity and Child Health Hospital (IPMCHH) from June 2016 to June 2020. The VTE group consisted of 38 women with postpartum VTE. For each VTE patient, 4 women without VTE who gave birth on the same day were randomly selected as the control group (n=152). The receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the discrimination, accuracy, and validity of the RCOG RAM. Univariable analysis and multivariable logistic regression analysis were used to identify other related factors for postpartum VTE. RESULTS Compared with the low-risk group, the risk of VTE was 9.75-fold greater in the intermediate-risk group, and 90.00-fold greater in the high-risk group. The area under curve (AUC) of the model was 0.828 (95% CI: 0.762-0.894), with a score of 2 as its best cut-off value, which exactly matched the criterion recommended by the RCOG guidelines for pharmacological thromboprophylaxis. The calibration curves and DCA of the model also showed good accuracy. In addition to the factors included in the RCOG RAM, glucocorticoid therapy during pregnancy (adjusted OR=6.72, 95% CI: 1.56-28.91) and previous use of IUD (adjusted OR=7.11, 95% CI: 1.45-34.93) were associated with increased risk of postpartum VTE. CONCLUSIONS The RCOG RAM was found to be effective in predicting postpartum VTE, and has certain guiding significance for postpartum thromboprophylaxis in China.
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Affiliation(s)
- Ying-Zhou Ge
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland).,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China (mainland).,Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai, China (mainland)
| | - Chen Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland).,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China (mainland).,Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai, China (mainland)
| | - Yan-Qing Cai
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland).,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China (mainland).,Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai, China (mainland)
| | - He-Feng Huang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland).,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China (mainland).,Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai, China (mainland)
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Mohzari YA, Asdaq SM, Bamogaddam RF, Alattas K, Asalmi S, Alshuraim RA. Postpartum prophylaxis of venous thromboembolism with anticoagulation: A case report. J Taibah Univ Med Sci 2021; 16:292-294. [PMID: 33897337 PMCID: PMC8046954 DOI: 10.1016/j.jtumed.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/06/2022] Open
Abstract
Although there is a remarkably high risk of venous thromboembolism (VTE) during pregnancy and postpartum, a cautious approach is needed while initiating therapeutic and prophylactic anticoagulant therapy. The merits of heparin for thromboprophylaxis in postpartum patients are exaggerated, and its risk is generally overlooked. This study aimed to report the inappropriate use of anticoagulants in postpartum patients. The patient in this report was a 31-year-old healthy woman who had had a normal spontaneous vaginal delivery and visited the hospital a 3-day history of small itchy blisters at the enoxaparin injection sites. An examination revealed class II obesity. The Naranjo Scale assessment showed the possibility of an enoxaparin-induced hypersensitivity reaction. The clinical care team decided to discontinue the heparin. A follow-up examination did not show any signs of VTE. Although many pregnant and postnatal women might need VTE prophylaxis, routine anticoagulation for such a population is not essential. Clinicians should weigh the risks versus benefits to avoid any adverse drug reactions that may occur with this class of medication.
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Affiliation(s)
- Yahya A. Mohzari
- Department of Clinical Pharmacy, King Saud Medical City, Riyadh, KSA
| | - Syed M.B. Asdaq
- Department of Pharmacology and Therapeutics, College of Pharmacy, AlMaarefa University, Riyadh, KSA
| | | | | | - Sami Asalmi
- Department of Clinical Pharmacy, King Saud Medical City, Riyadh, KSA
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Chen Y, Dai Y, Song J, Wei L, Ma Y, Tian N, Wang Q, Zhang Q, Zhang Y, Wang XL, Zhang J, Liu R. Establishment of a risk assessment tool for pregnancy-associated venous thromboembolism and its clinical application: protocol for a prospective observational study in Beijing. BMC Pregnancy Childbirth 2019; 19:294. [PMID: 31409379 PMCID: PMC6693270 DOI: 10.1186/s12884-019-2448-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 08/06/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The risk of venous thromboembolism (VTE) during pregnancy and puerperal periods is significantly higher than during the non-pregnant period and is one of the major causes of maternal mortality. Developed countries have promulgated guidelines for risk assessment and prevention of maternal VTE, and standardized management has led to a significant reduction in maternal mortality. However, there is a paucity of relevant research related to pregnancy and puerperal VTE in China. METHODS/DESIGN We will perform a prospective cohort study and recruit 13,000 pregnant women from 2018 to 2020 in Beijing, China. VTE risk assessment will be conducted using the Royal College of Obstetricians and Gynaecologists (RCOG) pregnancy and puerperal VTE risk-assessment-scoring tool during early and late pregnancy, as well as during the puerperal period. Venous ultrasonography of lower extremities, routine blood tests, and coagulation parameters will be examined. These VTE risk assessments will be performed again if patients have VTE-related symptoms during their pregnancies, or if any of the following occur: (1) patients are hospitalized over 7 days due to any pregnancy complications; (2) patients are placed under strict bed rest for ≥ 3 days to prevent miscarriage. For patients with a confirmed diagnosis of VTE, treatment and follow-up plans will be decided jointly by the obstetricians, vascular surgeons, and pulmonologists. All patients in the study will be followed up by dedicated healthcare providers for up to 42 days postpartum. Statistical analyses will be performed to test the feasibility of the RCOG scoring tool for the Chinese population. The RCOG scoring tool will then be revised based upon the characteristics of the Chinese population, and the revised assessment scoring tool will then be tested in the cohort to evaluate its efficacy. Finally, a pregnancy and puerperal VTE risk-assessment tool will be proposed based on our study results. DISCUSSION This study will establish a preliminary VTE risk-assessment tool that is applicable to pregnant and puerperal women in China and provide guidelines for further thrombophylactic interventions. Furthermore, we wish to draw increased attention to pregnancy-associated VTE to reduce VTE-related mortality. TRIAL REGISTRATION Chi CTR1800015848 (04/24/2018).
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Affiliation(s)
- Yi Chen
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251# Yao Jia Yuan Road, Chao Yang District, Beijing, 100026, China.
| | - Yan Dai
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251# Yao Jia Yuan Road, Chao Yang District, Beijing, 100026, China
| | - Jing Song
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251# Yao Jia Yuan Road, Chao Yang District, Beijing, 100026, China
| | - Ling Wei
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251# Yao Jia Yuan Road, Chao Yang District, Beijing, 100026, China
| | - Ying Ma
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251# Yao Jia Yuan Road, Chao Yang District, Beijing, 100026, China
| | - Ning Tian
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251# Yao Jia Yuan Road, Chao Yang District, Beijing, 100026, China
| | - Qian Wang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251# Yao Jia Yuan Road, Chao Yang District, Beijing, 100026, China
| | - Qian Zhang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251# Yao Jia Yuan Road, Chao Yang District, Beijing, 100026, China
| | - Yue Zhang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251# Yao Jia Yuan Road, Chao Yang District, Beijing, 100026, China
| | - Xiao Lan Wang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251# Yao Jia Yuan Road, Chao Yang District, Beijing, 100026, China
| | - Jun Zhang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251# Yao Jia Yuan Road, Chao Yang District, Beijing, 100026, China
| | - Rong Liu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251# Yao Jia Yuan Road, Chao Yang District, Beijing, 100026, China
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