Abstract Number: PB2524
Meeting: ISTH 2020 Congress
Background: Venous thromboembolism (VTE) during pregnancy is associated with significant morbidity and mortality. International guidelines recommend risk assessment during antepartum and postpartum period to inform VTE prophylaxis. Pregnancies in women with chronic physical disability (WWCPD) are increasing, VTE risk assessment can be challenging.
Aims: We aimed to evaluate physicians approach to VTE risk assessment of WWCPD during pregnancy.
Methods: A cross-sectional study consisting of an anonymous self-administered electronic questionnaire was sent to Hematologists, Maternal-fetal Medicine Specialists (MFM) and Internal Medicine Specialists across Canada.
Results: The survey was active from August 2019 to November 2019. Seventy-three participants responded to the survey, and 55 (75.3%) completed the survey. The survey sample consisted of 33 (60%) MFM specialists and 22 (40%) IM specialists (IM): 14 (25.5%) hematologists and 8 (14.5%) general internal medicine physicians. Participants were primarily from the Province of Ontario (58.2%), and the majority (94.5%) reported assessing less than five WWCPD during pregnancy yearly.
There was considerable variability regarding antithrombotic treatment strategy for the hypothetical case scenarios. The majority of MFM Specialists favoured antepartum and postpartum VTE prophylaxis for women using wheelchairs during pregnancy but not for women using walking aids. Most IM specialists favoured no antepartum or postpartum thromboprophylaxis for WWCPD using wheelchairs or walking aids unless they developed other risk factors. Most respondents favoured antepartum (67.3%) and postpartum (65.5%) VTE prophylaxis for women experiencing pregnancy within a year of spinal cord injury.
Conclusions: Our study suggests a variable approach to thromboprophylaxis in WWCPD and that most MFM specialists were comfortable with starting VTE prophylaxis. As well, MFM physicians appear to be more likely to consider thromboprophylaxis than IM physicians. Ongoing collaboration between MFM and IM, as well as further research to understand the actual risk of VTE is needed to improve evidence-based antenatal and postpartum care in this complex population.
To cite this abstract in AMA style:Kazi S, McLeod A, Berndl A. Approach to Venous Thromboembolism Risk in Women with Physical Disability in Pregnancy – Multidisciplinary Survey [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/approach-to-venous-thromboembolism-risk-in-women-with-physical-disability-in-pregnancy-multidisciplinary-survey/. Accessed March 3, 2021.
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