Can we profile patients at risk for thrombo-embolic events after delivery: a decade of follow up

Objective
Thrombo-embolic events (mainly pulmonary embolism [PE] and deep vein thrombosis [DVT]) are currently the primary cause for maternal death in the developed world. The study objective was to identify a profile of parturients at risk to develop thrombo-embolic events in the puerperium or later in life, during more than 10 years of follow-up.
Study Design
Based on the births cohort of all women who gave birth between the years 1987-1998 (n= 95,257), a nested case-control study was designed. Cases (n=316) were all women who during puerperium or within 10 years of follow-up had developed PE or DVT. Controls were all women (n=7980) who delivered within 2 days of the index delivery of the cases (the last delivery preceding the first occurrence of PE or DVT). Multiple logistic regression models were constructed in order to identify the risk profile associated with thrombo-embolic events.

Results
316 women that gave birth between the years 1987-1998 encountered a thrombo-embloic event in the puerperium or during the surveillance period of more than 10 years; 7980 controls were matched by the date of delivery. Independent risk factors during pregnancy to subsequently develop thrombo-embolic events in a follow-up period of more than 10 years are presented in the table (results from a multivariable analysis).
Risk factors for subsequent VTE events: results from a multivariable logistic regression analysis
Conclusion
Advanced maternal age, grandmultiparity, hypertensive disorders, caesarian section, obesity, stillbirth and peripartum hysterectomy are all independent risk factors for the development of venous thrombo-embolic events post birth or during more than 10 years of follow-up. A birth complicated with hysterectomy, stillbirth, or CS to older grandmultipara parturients with hypertensive disorder and obesity should be considered at risk for subsequent thrombo-embolic complications.