Abstract Number: PB2525
Meeting: ISTH 2020 Congress
Background: Venous thromboembolism (VTE) continues to be the leading cause of direct maternal death in the UK since 1985. At KCH, we utilise weight-based dosing of enoxaparin for thromboprophylaxis, based on RCOG criteria, during pregnancy (20mg od for women weighing
< 50kg, 40mg od (50-100kg), 80mg od (>100kg), 120mg od (>150kg)). The optimal dosing of thromboprophylaxis remains a topic of debate in the antenatal population.
Aims: To review the impact, of prescribing LMWH thromboprophylaxis in pregnant women on bleeding and VTE, seen between 01/01/2009 and 31/12/2018 in the haematology clinic at KCH.
Methods: All women referred to the haematology clinic and commenced on LMWH thromboprophylaxis antenatally were identified retrospectively from the electronic patient record (EPR) with data collected on demographics, the specific indication and dose of thromboprophylaxis prescribed. Bleeding, VTE and adverse events, were identified and recorded. Descriptive statistics was used to analyse the data.
Results: Over the 10-year period, 486 women had recognised risk factors for VTE and prescribed LMWH; mean age 34 (SD+/-5.7), mean pre-pregnancy weight 83.4kg (SD+/-23.8), mode gravida 2. The commonest indication for prescribing thromboprophylaxis (table 1) was thrombophilia (43%), with many women also having a history of VTE (36%).
|Risk factors||n (%)|
|Previous VTE||176 (36)|
|BMI > 30 kg/m2||92 (19)|
|Family history of VTE||65 (13)|
|Age > 35 years old||60 (12)|
|Parity > 3||55 (11)|
|Medical comorbidities||39 (8)|
|Previous pre-eclampsia||16 (3)|
[Table 1: The most prevalent VTE risk factors taken into account by clinicians when LMWH thromboprophylaxis was prescribed]
Most women (76.1%) were prescribed enoxaparin 40 mg daily. Nine (1.9%) women had objectively confirmed thromboembolic events with all of these women having a prior history of VTE. Bleeding was reported in 7.2%, with no major bleeding and most classified as nuisance bleeding (epistaxis) reported at scheduled reviews. A significant number of women (17.3%) reported bruising at the injection sites.
Conclusions: The low incidence of VTE in this cohort demonstrates the safety and efficacy of weight-based enoxaparin thromboprophylaxis during pregnancy.
To cite this abstract in AMA style:Rajaratnam N, Patel J, Roberts L, Czuprynska J, Patel R, Arya R. Thromboprophylaxis during Pregnancy – 10-year Review of Women Seen in the Haematology Clinic at King’s College Hospital (KCH) [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/thromboprophylaxis-during-pregnancy-10-year-review-of-women-seen-in-the-haematology-clinic-at-kings-college-hospital-kch/. Accessed September 29, 2023.
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