scholarly journals Hypertensive Complications of Pregnancy and Risk of Venous Thromboembolism

Hypertension ◽  
2020 ◽  
Vol 75 (3) ◽  
pp. 781-787
Author(s):  
Luuk J.J. Scheres ◽  
Willem M. Lijfering ◽  
Norbert F.M. Groenewegen ◽  
Sanne Koole ◽  
Christianne J.M. de Groot ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Postpartum Period ◽  
Reference Group ◽  
Later Life ◽  
Thrombotic Risk ◽  
Hazard Ratios ◽  
Anticoagulation Clinics ◽  
Pregnancy And Postpartum ◽  
Cox Proportional Hazard Models

Hypertension during pregnancy and preeclampsia are associated with increased arterial thrombotic risk in later life. Whether these complications are associated with risk of venous thromboembolism (VTE) on the short term after pregnancy and on the long term, that is, outside pregnancy, is largely unknown. We conducted a nationwide cohort study in women with at least 1 pregnancy and their first VTE risk by linking the Dutch perinatal registry (Perined) to anticoagulation clinics. We used Cox proportional hazard models to estimate hazard ratios (HRs) and corresponding 95% CI for VTE risk in women with hypertension during pregnancy, women with preeclampsia, compared with women with uncomplicated pregnancies (reference). A total of 1 919 918 women were followed for a median of 13.7 (interquartile range, 7.6–19.2) years for a total of 24 531 118 person-years in which 5759 first VTEs occurred; incidence rate: 2.3 (95% CI, 2.3–2.4) per 10 000 person-years. In the first pregnancy and 3-month postpartum period, VTE risk was higher in women with hypertension, HR, 2.0 (95% CI, 1.7–2.4), and highest among women with preeclampsia, HR, 7.8 (95% CI, 5.4–11.3), versus the reference group. On the long term, women with hypertension during pregnancy and preeclampsia had a higher VTE risk: HR, 1.5 (95% CI, 1.4–1.6) and HR, 2.1 (95% CI, 1.8–2.4), respectively, versus the reference group. When excluding events during pregnancy and postpartum, these HRs were 1.4 (95% CI, 1.3–1.5) and 1.6 (95% CI, 1.4–2.0), respectively. In conclusion, hypertension during pregnancy and preeclampsia are associated with an increased VTE risk during pregnancy and postpartum period and in the 13 years after.

scholarly journals Rivaroxaban Versus Warfarin for Management of Obese African Americans With Non-Valvular Atrial Fibrillation or Venous Thromboembolism: A Retrospective Cohort Analysis

2020 ◽  
Vol 26 ◽  
pp. 107602962095491
Author(s):  
Olivia S. Costa ◽  
Jan Beyer-Westendorf ◽  
Veronica Ashton ◽  
Dejan Milentijevic ◽  
Kenneth Todd Moore ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
African Americans ◽  
Major Bleeding ◽  
Cox Regression ◽  
Cohort Analysis ◽  
Bleeding Risk ◽  
Nonvalvular Atrial Fibrillation ◽  
Thrombotic Risk ◽  
Hazard Ratios

African Americans (AAs) and obese individuals have increased thrombotic risk. This study evaluated the effectiveness and safety of rivaroxaban versus warfarin in obese, AAs with nonvalvular atrial fibrillation (NVAF) or venous thromboembolism (VTE). Optum® De-Identified Electronic Health Record (EHR) data was used to perform separate propensity-score matched analyses of adult, oral anticoagulant (OAC)-naïve AAs with NVAF or acute VTE, respectively; who had a body mass index≥30kg/m2 and ≥12-months EHR activity with ≥1-encounter before OAC initiation. Cox regression was performed and reported as hazard ratios (HRs) with 95% confidence intervals (CIs). For the NVAF analysis, 1,969 rivaroxaban- and 1,969 warfarin-users were matched. Rivaroxaban was not associated with a difference in stroke/systemic embolism versus warfarin (HR = 0.88, 95%CI = 0.60-1.28), but less major bleeding (HR = 0.68, 95%CI = 0.50-0.94) was observed. Among 683 rivaroxaban-users with VTE, 1:1 matched to warfarin-users, rivaroxaban did not alter recurrent VTE (HR = 1.36, 95%CI = 0.79-2.34) or major bleeding (HR = 0.80, 95%CI = 0.37-1.71) risk versus warfarin at 6-months (similar findings observed at 3- and 12-months). Rivaroxaban appeared to be associated with similar thrombotic, and similar or lower major bleeding risk versus warfarin in these obese, AA cohorts.

Concentration of fibrin monomer in pregnancy and during the postpartum period

2019 ◽  
Vol 56 (6) ◽  
pp. 692-700
Author(s):  
Ann Helen Kristoffersen ◽  
Per Hyltoft Petersen ◽  
Line Bjørge ◽  
Thomas Røraas ◽  
Sverre Sandberg
Keyword(s):  
Venous Thromboembolism ◽  
Pregnant Women ◽  
Postpartum Period ◽  
Monomer Concentration ◽  
Blood Samples ◽  
Fibrin Monomer ◽  
Three Samples ◽  
Pregnancy And Postpartum ◽  
D Dimer ◽  
In Pregnancy

Background D-dimer increases during pregnancy and is problematic to use in the diagnosis of venous thromboembolism. Fibrin monomer represents an alternative biomarker for venous thromboembolism. However, to be useful in pregnancy, the fibrin monomer concentration should be stable throughout pregnancy and during postpartum. Methods To describe the course of fibrin monomer concentration during pregnancy and the postpartum period in healthy pregnant women and to compare their within-subject biological variation (CVI) with non-pregnant women. Blood samples were obtained every fourth week during pregnancy and three samples after delivery in 20 healthy women and every fourth week during a 40-week period in 19 healthy non-pregnant women. Fibrin monomer (STA Liatest FM, Stago) was analysed in duplicates for all samples. Concentrations of fibrin monomer in pregnant and non-pregnant women were compared and the CVI for fibrin monomer was calculated. Results The median fibrin monomer concentration in pregnant women was 6.2 mg/L (2.5 and 97.5 percentiles 3.7–10.8 mg/L) and in non-pregnant women 4.8 mg/L (3.6–8.2) ( P < 0.01). The fibrin monomer concentration was relatively stable during pregnancy, although a few unexplained high fibrin monomer concentrations were found during pregnancy/postpartum. Fibrin monomer CVI in pregnancy and postpartum was 20.6% (95% CI 18.3, 23.5) and in non-pregnant 16.1% (13.7, 18.9). Conclusions For clinical purposes, fibrin monomer concentration can be considered stable during pregnancy, although it is slightly higher than in non-pregnant women. Pregnant and non-pregnant women have the same CVI. The suitability of fibrin monomer in venous thromboembolism diagnosis in pregnant women should be validated in further studies.

Concealed pregnancies and protected postpartum periods

2020 ◽  
pp. 472-492
Author(s):  
Jan Brunson
Keyword(s):  
Maternal Health ◽  
Sexual Activity ◽  
Postpartum Period ◽  
Urban Community ◽  
Demographic And Health Survey ◽  
Ethnographic Interviews ◽  
Critical Junctures ◽  
Pregnancy And Postpartum ◽  
Nutritional Needs

This chapter analyses the delineation of what counts as a critical period for action and intervention in improving maternal health. Using ethnographic interviews alongside descriptive data from the Nepal Demographic and Health Survey, it analyses two critical junctures for maternal health, the antepartum and postpartum periods, in the context of a particular peri-urban community of Nepal. The postpartum period is socially recognized as sutkeri for Hindu Nepalis, a forty-day period in which a woman who gave birth is considered ritually polluted, but also particularly susceptible to long-term health problems if proper care is not taken for her body in its vulnerable state. This perception of bodily vulnerability and mandated care while sutkeri exists in stark contrast to the absence of such notions and protective practices for the period of pregnancy. Pregnancy, an outwardly visible sign of sexual activity, is a state that one should hide or minimize in order to maintain one’s reputation and honour as a woman. Women worked to conceal their pregnancies, and typically no or little extra care was provided to women to meet their nutritional needs or to enable them to avoid hard physical labour. However, intersecting statuses, such as caste and class, and contexts, such as agricultural households and multi-generational households, crosscut any simple characterizations of the pregnancy and postpartum periods—even within the confines of a subgroup of the Nepali population (Parbatiya) in a single community and place.

scholarly journals Incidence of venous thromboembolism following initiation of non-steroidal anti-inflammatory drugs in U.S. women

Rheumatology ◽  
2020 ◽  
Vol 59 (9) ◽  
pp. 2502-2511
Author(s):  
Tracy L Kinsey ◽  
Til Stürmer ◽  
Michele Jonsson Funk ◽  
Charles Poole ◽  
Ross J Simpson ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Observational Studies ◽  
Health Study ◽  
Calendar Time ◽  
Vein Thrombosis ◽  
Hazard Ratios ◽  
Risk Patients ◽  
Inflammatory Drugs ◽  
Deep Vein

Abstract Objective To evaluate the risk of venous thromboembolism (VTE, i.e. deep vein thrombosis or pulmonary embolism, or both) following new use of NSAIDs in a long-term cohort of U.S. women. Methods We investigated initiation of coxibs and traditional NSAIDs (excluding aspirin) and incident VTE in 39 876 women enrolled in the Women’s Health Study from 1993–95 and followed with yearly questionnaires until 2012. We defined initiation as the first reported use of NSAIDs for ≥4 days per month. Incident VTE was confirmed by an end point committee. We estimated hazard ratios (HRs) and risk differences (RDs, expressed as percentages) comparing NSAID initiation with non-initiation and acetaminophen initiation (active comparator) via standardization using a propensity score that incorporated age, BMI, calendar time, and relevant medical, behavioural, and socioeconomic variables updated over time. Results The HR (95% CI) for risk of VTE in the as treated analyses comparing initiation with non-initiation, was 1.5 (1.2, 1.8) for any NSAID, 1.3 (1.1, 1.7) for traditional NSAIDs, and 2.0 (1.3, 3.1) for coxibs, with 2-year RDs 0.11, 0.08 and 0.32, respectively. When comparing the risk of VTE after initiation of any NSAID with that after acetaminophen initiation, the HRs were 0.9 (0.6, 1.5), 0.9 (0.5, 1.5) and 1.4 (0.6, 3.4), with 2-year RDs 0.03, –0.01, and 0.13, respectively. Conclusion New use of NSAIDs was associated with increased VTE risk compared with non-use, but the association was null or diminished when compared with acetaminophen initiation. Elevated VTE risks associated with NSAID use in observational studies may in part reflect different baseline risks among individuals who need analgesics and may overstate the risk patients incur compared with pharmacologic alternatives.

scholarly journals R u a smkn m0m?: Aspects of a Text Messaging Smoking Cessation/Reduction Intervention for Younger Mothers

2013 ◽  
Vol 10 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Sophie Soklaridis ◽  
Jenna López ◽  
Karina Czyzewski ◽  
Rosa Dragonetti ◽  
Peter Selby
Keyword(s):  
Smoking Cessation ◽  
Focus Groups ◽  
Young Women ◽  
Postpartum Period ◽  
Text Messaging ◽  
Unmet Need ◽  
Postpartum Women ◽  
Telephone Interviews ◽  
Pregnancy And Postpartum

Introduction: Women who are younger in age are more likely to smoke during pregnancy and postpartum and tend to have less success with cessation/reduction. There is an unmet need for interventions targeted to pregnant and postpartum young women that provide them with support to quit/reduce long-term into the postpartum period and beyond.Aims: Our study aimed to gain an in-depth understanding of the perspectives of young pregnant and postpartum women of text messaging (TM) as a conduit for smoking cessation/reduction, and to determine the appropriate content, frequency, duration and unique features needed for an effective cessation/reduction TM programme.Methods: Six focus groups and six telephone interviews were convened with 36 pregnant and postpartum women 16–30 years of age.Results: Three main themes were identified: 1) topic areas that women would like TM to focus on; 2) the need for messages to be tailored; and 3) the importance for the programme to take a woman-centered approach.Conclusions: Respondents supported the idea of a TM cessation/reduction intervention and had clear programme recommendations. A personalised, woman-centered TM programme that meets a young woman's unique needs and addresses her concerns through her participation and direction is likely to empower and support her to quit/reduce.

scholarly journals A Case Report : Pregnancy with Multiple Sclerosis

2020 ◽  
Vol 9 (1-2) ◽  
pp. 93-95
Author(s):  
Shiuly Chowdhury ◽  
Nilufar Islam ◽  
Khadiza Nurun Nahar ◽  
Kaniz Fatema ◽  
Salma Akter Munmun ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Young Adults ◽  
Case Report ◽  
Pregnant Woman ◽  
Postpartum Period ◽  
Clinical Course ◽  
Child Bearing ◽  
Pregnancy And Postpartum ◽  
Do So

Multiple sclerosis causes disability in young adults and like most autoimmune diseases, affects women more commonly in their child-bearing years. In general, pregnancy does not appear to affect the long-term clinical course of multiple sclerosis and the disease does not affect the course or outcome of pregnancy. In this reportedcase, a pregnant woman with multiple sclerosis showed relapse of the disease in first half of her pregnancy and disease was well controlled in the second half of her pregnancy and postpartum period after taking appropriate measure. Women who have multiple sclerosis and wish to have a family can usually do so successfully with the assistance of their neurologist and obstetrician. Ibrahim Card Med J 2019; 9 (1&2): 93-95

scholarly journals Prophylaxis and management of venous thromboembolism during pregnancy and postpartum period

2021 ◽  
Vol 15 (5) ◽  
pp. 599-616
Author(s):  
V. Ya. Khryshchanovich ◽  
N. Ya. Skobeleva
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Pregnant Women ◽  
Postpartum Period ◽  
Anticoagulation Therapy ◽  
Total Duration ◽  
Factor Xa ◽  
Pregnancy And Postpartum ◽  
Routine Administration ◽  
History Of

Introduction. Venous thromboembolism (VTE) is one of the lead causes for maternal mortality and morbidity during pregnancy in the majority of developed countries. The incidence rate of VTE per pregnancy-year increases during pregnancy and postpartum period about by 4-fold and at least 14-fold, respectively.Aim: to analyze and summarize current view on risk factors of thrombotic events during gestation and to discuss recent guidelines for the management of venous thromboembolic complications during pregnancy and postpartum, by taking into account a balance between risks and benefits of using anticoagulants.Materials and Methods. The literature search covering the last 10 years was carried out in the electronic scientific databases RSCI, PubMed/MEDLINE, and Embase. While formulating a search strategy for evidence-based information, the PICO method (P = Patient; I = Intervention; C = Comparison; O = Outcome) and the key terms “venous thromboembolism” and “pregnancy” were used.Results. Risk factors were found to include a personal history of VTE, verified inherited or acquired thrombophilia, a family history of VTE and general medical conditions, such as immobilization, overweight, varicose veins, some hematological diseases and autoimmune disorders. VTE is considered being potentially preventable upon prophylactic administration of anticoagulants, but no high confidence randomized clinical trials comparing diverse strategies of thromboprophylaxis in pregnant women have been proposed so far. Because heparins do not cross the placenta, weight-adjusted therapeutic-dose low molecular weight heparins (LMWH) represent the anticoagulant treatment of choice for VTE during pregnancy. Once- and twice-daily dosing regimens are acceptable. However, no evidence suggesting benefits for measurement of factor Xa activities and consecutive LMWH dose adjustments to improve clinical outcomes are available. In case of uncomplicated pregnancy-related VTE, no routine administration of vitamin K antagonists, direct thrombin or factor Xa inhibitors, fondaparinux, or danaparoid is recommended. Lactating women may switch from applying LMWH to warfarin. Anticoagulation therapy should be continued for 6 weeks postpartum with total duration lasting at least for 3 months.Conclusion. VTE is a challenging task in pregnant women expecting to apply a multi-faceted approach for its efficient solution by taking into account updated recommendations and personalized patient-oriented features.

Venous thromboembolism during pregnancy and postpartum period

2021 ◽  
Author(s):  
Syed Bukhari ◽  
Shumail Fatima ◽  
Amr F. Barakat ◽  
Annemarie E. Fogerty ◽  
Ido Weinberg ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Postpartum Period ◽  
Pregnancy And Postpartum

Physical Activity Trajectories During Adulthood and Incident Hypertension: A National Longitudinal Cohort Study

2020 ◽  
Author(s):  
Gui-zhen Cao ◽  
Cong-ju Wang ◽  
Hao-yu Dong ◽  
Zhi-zhen Cui ◽  
Ya-na Ma ◽  
...  
Keyword(s):  
Physical Activity ◽  
Early Adulthood ◽  
Later Life ◽  
Nutrition Survey ◽  
Gradual Decline ◽  
Incident Hypertension ◽  
Health And Nutrition ◽  
Cox Proportional Hazard ◽  
Hazard Ratios

Abstract Background We aimed to characterize the physical activity (PA) trajectories across adulthood and estimate their association with incident hypertension risk.Methods Data were obtained from the China Health and Nutrition Survey (CHNS) conducted during 2004–2011. Group-based trajectory modeling (GBTM) was used to identify distinct groups of PA trajectories. The Cox proportional hazard model was used to investigate the association between each PA trajectory group and incident hypertension.Results A total of 11,162 participants whose PA was repeatedly measured two to four times in the CHNS during 2004–2011 were included in our study. During the 5.4 years of follow-up, 3,824 incident hypertension cases were identified. Five distinct PA trajectories were identified in men: light and slight decline, light and gradual decline then sharp rise, light to medium-heavy then decline, medium-heavy and persistent decline, and heavy and sharp decline. Two distinct PA trajectories were identified in women: light and stable, and medium and gradual decline. The PA trajectory of medium-heavy and persistent decline was significantly associated with decreased risk of hypertension in men, with the hazard ratios and 95% confidence intervals being 0.80 (0.63, 0.99), 0.74 (0.59, 0.93), 0.76 (0.60, 0.96), and 0.70 (0.55, 0.88) in model 1, model 2, model 3, and model 4, respectively.Conclusions Our study identified five distinct long‐term PA trajectories in men and two distinct trajectories in women. The PA trajectory of medium-heavy PA in early adulthood (at 18–37 years) followed by persistent decline (at 38–70 years) was found to be significantly associated with a decreased risk of hypertension in later life in men.

Influence of Sickle Cell Trait on the Risk of Venous Thromboembolism In Pregnancy and the Postpartum

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1628-1628 ◽  
Author(s):  
Sofya Pintova ◽  
Henny Heisler Billett
Keyword(s):  
Venous Thromboembolism ◽  
Sickle Cell ◽  
Postpartum Period ◽  
Conflicts Of Interest ◽  
Sickle Cell Trait ◽  
Pregnancy And Postpartum ◽  
Venous Thromboembolic Events ◽  
Group A ◽  
Group B ◽  
In Pregnancy

Abstract Abstract 1628 Background: Evidence suggests a disparity in the incidence of venous thromboembolic events (VTE) amongst racial groups, with blacks purported to have a higher occurrence of VTE than whites. In contrast, Hispanics and Asians have been observed to have a lower occurrence of VTE. Sickle cell anemia is a known prothrombotic state and recent studies contend that sickle cell trait (SCT) may also predispose to VTE. We hypothesized that SCT might play a role in the increased VTE risk for blacks. To this end, we conducted a study to investigate whether pregnant/postpartum women with SCT have a higher VTE incidence than controls without SCT. Methods: Patient information was obtained using our hospital database spanning the eleven years 1998–2008. All pregnant women seen in our large urban medical center had hemoglobin (Hb) electrophoresis screening on their first clinic visit; demographic data was obtained from the patient at registration. Using prospectively-collected data, three patient cohorts were identified. Group A included women with SCT as identified by %HbS of 30–45% on Hb electrophoresis. To ensure exclusion of patients with sickle cell disease who were post-transfusion, subjects who at any time in their medical record had %HbS >45% were excluded from analysis. HbAA black (Group B) and white (Group C) cohorts were included if %HbA was ≥95.5%. Women who self-identified themselves as Hispanic, multiracial, “declined”, “not available” or “not applicable” were also excluded. VTE cases were identified using ICD-9 codes from hospital, ER or outpatient visit discharges during the pregnancy or postpartum period (294 days before delivery or 56 days after delivery). All charts of VTE indexed cases were reviewed (by SP) to ensure accuracy of reporting. Results: The prevalence of SCT was found to be high (11.1%) in our Group A population as compared to 8.3% in the general pregnant/postpartum non-white population that included Hispanics, multiracial and unavailable individuals. We identified 679 black subjects with SCT, 5465 black subjects with HbAA and 1162 white subjects with HbAA. VTE incidence was 0.44% in Group A (SCT), in 0.49% in Group B (Black AA) and in 0.26% in Group C (White AA). The rate of VTE did not significantly differ between these groups. When patients were included who had been thromboprophylaxed secondary to previous VTEs, the incidence of VTE in Black AA was 0.6%, still not significantly different from the white AA group (p=0.13). Age was a more important factor: patients with VTE were significantly older than non-VTE pregnant patients (mean 32.2 vs. 27.6 years, p=0.0002). As expected, the majority of VTE occurred in the postpartum period (61%). Conclusion: Our results suggest that there is a nonsignificant trend toward a higher incidence of VTE in black HbAA (Group B) as compared to white women with HbAA (Group C) in the pregnant/postpartum period. We could not detect a difference in VTE incidence between black SCT (Group A) and black HbAA (Group B). The role of sickle cell trait as an inherited prothrombotic mutation remains unclear. Even a mild increase in age appears to constitute a prothrombotic risk. However, as VTE remains one of the major causes of maternal mortality, further studies will be needed to better identify risk factors of VTE in pregnancy. Prospective studies identifying such patients may help characterize the true impact of sickle cell trait on venous thromboembolism in pregnancy and postpartum. Disclosures: No relevant conflicts of interest to declare.

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