Document Detail


Postpartum management of women at increased risk of thrombosis--results of a Canadian pilot survey.
MedLine Citation:
PMID:  16981294     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine current practice patterns in the postpartum management of women at increased risk of thrombosis. METHODS: Physicians affiliated with the University of Toronto departments of Obstetrics and Gynecology, Rheumatology, Hematology, and Obstetric Medicine who provide care to pregnant women were mailed a questionnaire that presented 6 clinical scenarios involving postpartum management of a woman at risk for thrombosis, with (1) recurrent pregnancy loss and antiphospholipid antibody syndrome (APS) treated with aspirin (ASA) in the pregnancy; (2) 2 pregnancy losses and a low titer antiphospholipid antibody (aPL) treated with ASA and low molecular weight (LMW) heparin with placental insufficiency; (3) known APS and pregnancy loss treated with LMW heparin and delivered by cesarean section; (4) a previous 17 week fetal death and aPL; (5) a previous deep vein thrombosis while on oral contraception; and (6) systemic lupus erythematosus and secondary APS with a history of a stillbirth. Physicians were asked whether they would recommend postpartum coagulation, and if so to choose from a list of treatment options. RESULTS: Of the 71 questionnaires mailed, 44 were returned (62%). Three physicians replied that their practices do not include patients similar to those presented in the cases and chose not to respond to the clinical scenarios. Percentages of responders recommending treatment in each scenario were 29% for Case 1, 49% for Case 2, 63% for Case 3, 41% for Case 4, 51% for Case 5, and 58% for Case 6. Recommendation for treatment differed among medical specialties, with rheumatologists being less likely to treat in all cases. Prophylactic heparin was selected as the treatment of choice most frequently by those recommending anticoagulation 70% (84/120). CONCLUSION: Postpartum treatment recommendations for women at increased risk of thrombosis are variable across different practitioner specializations demonstrating clinical equipoise regarding therapy. More definitive research is needed and broader study of physicians involved in the care of these patients is planned to more accurately describe and understand the decision to treat these patients.
Authors:
Karen A Spitzer; Kellie Murphy; Mark Crowther; Christine A Clark; Carl A Laskin
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Publication Detail:
Type:  Journal Article     Date:  2006-09-15
Journal Detail:
Title:  The Journal of rheumatology     Volume:  33     ISSN:  0315-162X     ISO Abbreviation:  J. Rheumatol.     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-11-06     Completed Date:  2007-01-26     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  7501984     Medline TA:  J Rheumatol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  2222-6     Citation Subset:  IM    
Affiliation:
Department of Medicine, University of Toronto and Mount Sinai Hospital, Hamilton, Ontario, Canada. kspitzer@istar.ca
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MeSH Terms
Descriptor/Qualifier:
Antibodies, Antiphospholipid / drug effects*
Canada
Female
Health Care Surveys
Heparin / therapeutic use
Humans
Medicine / statistics & numerical data
Physician's Practice Patterns / statistics & numerical data*
Pilot Projects
Postpartum Period*
Pregnancy
Pregnancy Complications, Cardiovascular / prevention & control*
Specialization
Thrombosis / prevention & control*
Chemical
Reg. No./Substance:
0/Antibodies, Antiphospholipid; 9005-49-6/Heparin
Comments/Corrections
Comment In:
J Rheumatol. 2006 Nov;33(11):2108-9   [PMID:  17086598 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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