High risk of long-term recurrence after a first episode of venous thromboembolism during pregnancy or postpartum: the REcurrence after a PrEgnAncy related Thrombosis (REPEAT) Study.

IF 5.5 2区 医学 Q1 HEMATOLOGY Journal of Thrombosis and Haemostasis Pub Date : 2024-10-30 DOI:10.1016/j.jtha.2024.09.039
Manal Ibrahim-Kosta, Sarah El Harake, Barbara Leclercq, Céline De Mari, Jean-François Secondi, Emilie Paoletti, Pierre Suchon, Yasmine Benredouane, Dominique Brunet, Marie-Christine Barthet, Maria Bruzelius, Gaëlle Munsch, David-Alexandre Trégouët, Pierre-Emmanuel Morange, Louisa Goumidi, Gabrielle Sarlon-Bartoli
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Abstract

Introduction: Long term-recurrence risk following a pregnancy associated venous thromboembolism (VTE) is sparsely assessed.

Objective: To determine the rate of recurrence after a pregnancy associated VTE, and identify associated risk factors.

Method: Five hundred and eighty-seven women with a history of first VTE occurring during pregnancy or until 3 months after delivery were referred to La Timone Hospital, Marseille, France. Women were consecutively included between 2000 and 2015. VTE characteristics and biological parameters were collected at inclusion. During the 2016-2019 period, patients were recontacted to gather information on post-inclusion VTE. A weighted Cox model, adapted to the study's ambispective design, was used to analyse pre- and post-inclusion VTE recurrences.

Results: After quality controls, 583 women were analyzed. Incidence of recurrent VTE was 2.4% person-years. Cumulative risk of VTE recurrence was 38% (n=221), with a median follow-up of 31 years (95%CI [27-35]); 6%, 13%, 17%, 30% at 2, 5, 10 and 30 years respectively. Pulmonary embolism (PE) at first event was associated with a 2-fold increased risk of PE at recurrence compared with isolated deep venous thrombosis (DVT, Hazard Ratio (HR)=2.63, 95%CI [1.44-4.82]). Risk factors significantly associated with recurrence were: interrupted pregnancies (HR=1.85, 95%CI [1.18-2.90]; lower limb DVT (HR=2.95, 95%CI [1.16-7.49] and AB blood group (HR=1.71, 95%CI [1.06-2.77]).

Conclusion: Although the recurrence risk is low within the first 10 years after a pregnancy associated VTE, 1/3 patients experienced a new event over a 30-year period. Interrupted pregnancies, lower limb DVT, and AB blood group were associated with higher risk of recurrence.

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孕期或产后首次发生静脉血栓栓塞后长期复发的高风险:与血栓形成有关的孕期或产后复发(REPEAT)研究。
导言:对妊娠合并静脉血栓栓塞症(VTE)后的长期复发风险评估很少:目的:确定妊娠合并 VTE 后的复发率,并确定相关风险因素:法国马赛 La Timone 医院收治了 587 名妊娠期或产后 3 个月内首次发生 VTE 的妇女。这些妇女在 2000 年至 2015 年间被连续纳入。纳入时收集了 VTE 特征和生物参数。在 2016 年至 2019 年期间,再次联系了患者,以收集纳入后 VTE 的信息。根据研究的前瞻性设计,采用加权Cox模型分析纳入前和纳入后的VTE复发情况:结果:经过质量控制后,共对 583 名妇女进行了分析。VTE复发率为2.4%人年。VTE复发的累积风险为38%(n=221),中位随访时间为31年(95%CI [27-35]);2年、5年、10年和30年的累积风险分别为6%、13%、17%和30%。与孤立的深静脉血栓形成(DVT,危险比(HR)=2.63,95%CI [1.44-4.82])相比,首次发生肺栓塞(PE)时复发的风险增加了 2 倍。与复发明显相关的风险因素有:间断妊娠(HR=1.85,95%CI [1.18-2.90];下肢深静脉血栓(HR=2.95,95%CI [1.16-7.49])和 AB 血型(HR=1.71,95%CI [1.06-2.77]):尽管妊娠相关性 VTE 在发生后的前 10 年内复发风险较低,但 30 年内仍有三分之一的患者再次发生 VTE。中断妊娠、下肢深静脉血栓和 AB 血型与较高的复发风险有关。
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来源期刊
Journal of Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis 医学-外周血管病
CiteScore
24.30
自引率
3.80%
发文量
321
审稿时长
1 months
期刊介绍: The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.
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