Joyce Lai1, Isvarya Venu2, Ann Kinga Malinowski3, Shital Gandhi4, Anne McLeod5, Rosane Nisenbaum6, Nusrat Zaffar7, Nadine Shehata8. 1. a Faculty of Medicine , University of Toronto , Toronto , Canada. 2. b School of Medicine, Trinity College , Dublin , Ireland. 3. c Departments of Obstetrics/Gynecology and Medicine , University of Toronto, Division of Maternal-Fetal Medicine, Special Pregnancy Program, Mount Sinai Hospital , Toronto , Canada. 4. d Department of Medicine, Division of General Internal Medicine , University of Toronto, Special Pregnancy Program, Mount Sinai Hospital , Toronto , Canada. 5. e Department of Medicine, Division of Hematology , University of Toronto, Sunnybrook Health Sciences Centre , Toronto , Canada. 6. f Li Ka Shing Knowledge Institute , Toronto , Canada. 7. g Mount Sinai Hospital , Toronto , Canada. 8. h Departments of Medicine and Laboratory Medicine and Pathobiology , University of Toronto, Division of Hematology, Special Pregnancy Program, Mount Sinai Hospital , Toronto , Canada.
Abstract
OBJECTIVES: As thromboembolism (TE) continues to be one of the principal causes of death in obstetrical patients and as the postpartum period is associated with the highest risk for TE, we sought to determine the risk factors associated with TE following cesarean section (CS). METHODS: A retrospective analysis of patients who had CS at a large tertiary referral center was conducted. Patients were identified through hospital medical records and were contacted approximately 1 year following their CS. Medical records and a questionnaire were used to identify features that were potentially associated with TE. Univariate analysis was used to determine the risk associated with these characteristics. RESULTS: A total of 2206 patients had a CS, of which 1377 (62%) participated. Of the respondents, 137 patients received heparin (94% received a prophylactic dose, 6% received a therapeutic dose) and the remainder, 1233 patients, did not receive heparin. Seven patients (0.5%) developed a TE and 86% developed a TE within 7 days of CS. The odds ratio (OR) for TE for women with hypertension prior to pregnancy compared to patients who did not receive anticoagulation was 21.28 [95% confidence interval (CI) 4.64-90.13] and for patients who had varicose veins with superficial thrombophlebitis when compared to patients who had received heparin postpartum was 21.01 (95% CI 1.55-288.24). DISCUSSION: Hypertension and the presence of varicose veins were associated with TE following CS. Larger cohort analyses are required to confirm these associations so that risk scores incorporating these characteristics may accurately predict the occurrence of TE.
OBJECTIVES: As thromboembolism (TE) continues to be one of the principal causes of death in obstetricalpatients and as the postpartum period is associated with the highest risk for TE, we sought to determine the risk factors associated with TE following cesarean section (CS). METHODS: A retrospective analysis of patients who had CS at a large tertiary referral center was conducted. Patients were identified through hospital medical records and were contacted approximately 1 year following their CS. Medical records and a questionnaire were used to identify features that were potentially associated with TE. Univariate analysis was used to determine the risk associated with these characteristics. RESULTS: A total of 2206 patients had a CS, of which 1377 (62%) participated. Of the respondents, 137 patients received heparin (94% received a prophylactic dose, 6% received a therapeutic dose) and the remainder, 1233 patients, did not receive heparin. Seven patients (0.5%) developed a TE and 86% developed a TE within 7 days of CS. The odds ratio (OR) for TE for women with hypertension prior to pregnancy compared to patients who did not receive anticoagulation was 21.28 [95% confidence interval (CI) 4.64-90.13] and for patients who had varicose veins with superficial thrombophlebitis when compared to patients who had received heparin postpartum was 21.01 (95% CI 1.55-288.24). DISCUSSION: Hypertension and the presence of varicose veins were associated with TE following CS. Larger cohort analyses are required to confirm these associations so that risk scores incorporating these characteristics may accurately predict the occurrence of TE.