Pregnancy-Associated Venous Thromboembolism: Insights from GARFIELD-VTE

C. Jerjes-Sanchez^1,2, D. Rodriguez^1,2, A.E. Farjat³, G. Kayani³, P. MacCallum^3,4, R.D. Lopes⁵, A.G.G. Turpie⁶, J.I. Weitz^6,7, S. Haas⁸, W. Ageno⁹, S. Goto¹⁰, S.Z. Goldhaber¹¹, P. Angchaisuksiri¹², J. Dalsgaard Nielsen¹³, S. Schellong¹⁴, H. Bounameaux¹⁵, L.G. Mantovani^16,17, P. Prandoni¹⁸, A.K. Kakkar^3,19, on Behalf of the GARFIELD-VTE Investigators

¹Escuela de Medicina y Ciencias de la Salud. Tecnológico de Monterrey, Monterrey, Mexico, ²Instituto de Cardiología y Medicina Vascular, TecSalud, Monterrey, Mexico, ³Thrombosis Research Institute, London, United Kingdom, ⁴Queen Mary University of London, London, United Kingdom, ⁵Duke Clinical Research Institute, Division of Cardiology, Duke University Medical Centre, Durham, United States, ⁶McMaster University, Hamilton, Canada, ⁷Thrombosis and Atherosclerosis Research Institute, Hamilton, Canada, ⁸Formerly Technical University of Munich, Munich, Germany, ⁹University of Insubria, Department of Medicine and Surgery, Varese, Italy, ¹⁰Tokai University, Department of Medicine (Cardiology), Tokai, Japan, ¹¹Harvard Medical School, Boston, United States, ¹²Ramathibodi Hospital, Mahidol University, London, United Kingdom, ¹³Copenhagen University Hospital, Copenhagen, Denmark, ¹⁴Municipal Hospital Dresden, Dresden, Germany, ¹⁵University Hospital of Geneva, Faculty of Medicine, Geneva, Switzerland, ¹⁶IRCCS Multimedica, Milan, Italy, ¹⁷University of Milano, Bicocca, Italy, ¹⁸Arianna Foundation on Anticoagulation, Bologna, Italy, ¹⁹University College London, London, United Kingdom

Abstract Number: PB2310

Meeting: ISTH 2020 Congress

Theme: Venous Thromboembolism and Cardioembolism » VTE Epidemiology

Background: The risk of venous thromboembolism (VTE) is increased in pregnancy and postpartum such that VTE is a leading cause of maternal mortality.

Aims: Investigate the clinical characteristics, diagnostic strategies, treatment patterns and 12-month outcomes of women with pregnancy-associated VTE enrolled in the Global Anticoagulant Registry in the FIELD (GARFIELD)-VTE.

Methods: GARFIELD-VTE (ClinicalTrials.gov: NCT02155491) is a non-interventional study observing real-world treatment practices. Of the 10,870 patients with objectively confirmed VTE enrolled between May 2014 and January 2017, women of childbearing age (< 45 years) were stratified into those with (n=183) or without (n=1187) pregnancy-associated VTE.

Results: Women with pregnancy-associated VTE were younger (30.5 years vs. 34.8 years) and less likely to have had a pulmonary embolism (PE) than those without (19.7% vs. 32.3%). Deep vein thrombosis (DVT) in women with pregnancy-associated VTE occurred more frequently in the left leg (73.9%) than in women without pregnancy-associated VTE (54.8%). The most common VTE risk factors in pregnancy-associated VTE patients were hospitalisation (10.4%), previous surgery (10.4%), and family history of VTE (9.3%). Compression ultrasonography was used to diagnose DVT in 98.7% of pregnancy-associated VTE patients, whilst spiral/chest computed tomography scan was frequently used to diagnose PE (75.0%). 43.2% of pregnancy-associated VTE patients received parenteral therapy alone, 50.4% received a VKA or a DOAC (Figure 1). After adjustment for baseline characteristics, the risk of all-cause mortality (HR 0.59 [95% CI: 0.18-1.98]), recurrent VTE (HR 0.82 [95% CI 0.34-1.94]) and major bleeding
(HR 1.13 [95% CI 0.33-3.90]) were comparable between patients with or without pregnancy-associated VTE (Table 1).

Conclusions: Half of all patients with pregnancy-associated VTE received either a VKA or a DOAC, despite limited evidence for their use in this population. The rate of clinical outcomes was comparable between patient groups.

[Figure 1. Anticoagulant treatment at baseline (up to 30 days after VTE diagnosis). ]

[Table 1: 12-month clinical outcomes.]

To cite this abstract in AMA style:

Jerjes-Sanchez C, Rodriguez D, Farjat AE, Kayani G, MacCallum P, Lopes RD, Turpie AGG, Weitz JI, Haas S, Ageno W, Goto S, Goldhaber SZ, Angchaisuksiri P, Dalsgaard Nielsen J, Schellong S, Bounameaux H, Mantovani LG, Prandoni P, Kakkar AK, on Behalf of the GARFIELD-VTE Investigators . Pregnancy-Associated Venous Thromboembolism: Insights from GARFIELD-VTE [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/pregnancy-associated-venous-thromboembolism-insights-from-garfield-vte/. Accessed December 6, 2023.

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