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[Prevention of thrombosis during pregnancy: from recommendations to practice from 26 cases]
M Epinat1, A Buchmüller-Cordier, D Delsart
1Groupe de Recherche de la Thrombose (EA 3065), Service de Médecine Interne et Thérapeutique, CHU Saint-Etienne Bellevue, France.
Recommendations have recently been published regarding the prescription of low-molecular-weight heparin (LMWH) during pregnancy in women at risk of thromboembolism. To assess how well these recommendations are followed, we retrospectively recorded all pregnancy consultations in a thrombosis unit for two years. Of the 26 women included (mean age 30 +/- 4.8 years), 81% presented with a history of thromboembolism, 35% thrombophilia, and 15% a history of pregnancy termination for medical reasons. Clinical follow-up concerned 17% of the women; 8% were given aspirin, 63% LMWH at prophylactic dosages, 4% combination of aspirin and prophylactic LMWH, and 8% were on curative LMWH. Neither thromboembolic nor neonatal events were observed. One case of termination of pregnancy for medical reasons was observed at the 5th month. Although we also took into account the gravity of previous thromboembolism, our prescriptions were globally in compliance with the recommendations. This approach has still to be validated with a decision-making tree.
Recommendations have recently been published regarding the prescription of low-molecular-weight heparin (LMWH) during pregnancy in women at risk of thromboembolism. To assess how well these recommendations are followed, we retrospectively recorded all pregnancy consultations in a thrombosis unit for two years. Of the 26 women included (mean age 30 +/- 4.8 years), 81% presented with a history of thromboembolism, 35% thrombophilia, and 15% a history of pregnancy termination for medical reasons. Clinical follow-up concerned 17% of the women; 8% were given aspirin, 63% LMWH at prophylactic dosages, 4% combination of aspirin and prophylactic LMWH, and 8% were on curative LMWH. Neither thromboembolic nor neonatal events were observed. One case of termination of pregnancy for medical reasons was observed at the 5th month. Although we also took into account the gravity of previous thromboembolism, our prescriptions were globally in compliance with the recommendations. This approach has still to be validated with a decision-making tree.