Bénéfice de la prévention des évènements thrombotiques guidée par le score STRATHEGE chez la femme enceinte : une étude contrôlée avant et après sa mise en oeuvre.

Titre original :

Benefit of Risk Score-Guided Prophylaxis in Pregnant Women at Risk of Thrombotic Events: A Controlled Before-and-After Implementation Study.

Titre en français :

Auteurs :

Chauleur C, Gris JC, Laporte S, Chapelle C, Bertoletti L, Equy V, Gaucherand P, Bazan E, Dupuis O, Gallot D, Mismetti P; STRATHEGE Investigators and The STRATHEGE Group.

Revue :

Thromb Haemost. 2018 Sep;118(9):1564-1571.

Résumé :

BACKGROUND:
Management of pregnant women at risk of venous thromboembolism (VTE) and placental vascular complications (PVCs) remains complex. Guidelines do not definitively specify optimal strategies.

OBJECTIVE:
Our objective was to evaluate the impact of employing risk score-driven prophylaxis strategies on VTE and PVC rates in at-risk pregnant women.

MATERIALS AND METHODS:
This study, conducted in 21 French maternity units, compared VTE and PVC rates before and after implementation of a risk scoring system to determine prophylactic strategies.

RESULTS:
A total of 2,085 pregnant women at risk of VTE or PVC were enrolled. Vascular events occurred in 190 (19.2%) patients before and 140 (13.0%) after implementation of risk score-driven prophylaxis (relative risk [RR] = 0.68 [0.55; 0.83]). The incidence of deep vein thrombosis during pregnancy was reduced (RR = 0.30 [0.14; 0.67]). PVC comprised mainly pre-eclampsia, occurring in 79 patients before and 42 patients after risk score implementation (RR = 0.52 [0.36; 0.75]). Post-partum haemorrhage occurred in 32 patients (3.2%) before and 48 patients (4.5%) after risk score implementation (RR = 1.38 [0.89; 2.13], p = 0.15).

CONCLUSION:
Use of a simple risk scoring system, developed by experts in VTE and PVC research to guide prophylaxis, reduced the risk of thrombotic events during pregnancy without any significant increase in bleeding risk.