Preferences of pregnant women for postpartum thromboprophylaxis : the bicentric PREFER-PostPartum study

Article Article scientifique Article Preferences of pregnant women for postpartum thromboprophylaxis : the bicentric PREFER-PostPartum study eng 2024-07-05 2024-10 author Blondon Marc 0000-0001-7032-9491 Division of Angiology and Hemostasis, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland. Electronic address: marc.blondon@hcuge.ch. 503046 Département de médecine (DEMED) author Lansiaux Maud Gynecology Department, Gynaecological Endocrinology Unit, Hospital Saint Joseph, Paris, France. author Bryan Saskia Nadjezda Buxton Faculty of Medicine, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland. 850313 author Dongala Amélie Gynecology Department, Gynaecological Endocrinology Unit, Hospital Saint Joseph, Paris, France. author Pavoncello Romain Paul Faculty of Medicine, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland. 845011 author Chatellier Gilles Clinical Research Unit, Paris Saint Joseph Hospital, Paris, France. author Claver Marine Division of Obstetrics, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland. 972298 author Azria Elie Maternity Unit, Paris Saint Joseph Hospital, Fédération Hospitalo-Universitaire Combattre la prématurité, Paris, France; Université de Paris Cité, Centre de Recherche en Epidémiologie et Statistiques, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Equipe de recherche en épidémiologie obstétricale périnatale et pédiatrique, Institut national de la santé et de la recherche médicale, Paris, France. author Martinez De Tejada Weber Begona Division of Obstetrics, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland. 590919 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) author Hugon Justine Gynecology Department, Gynaecological Endocrinology Unit, Hospital Saint Joseph, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, France; Division of Gynecology, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland. 867985 2834-2843 10.1016/j.jtha.2024.06.019 38972385 1538-7836 https://www.sciencedirect.com/science/article/pii/S1538783624003805 Background: Clinical guidelines for postpartum thromboprophylaxis differ due to its uncertain effect and varying preferences of experts. Women's preferences for postpartum thromboprophylaxis are unknown, although they may inform practices and future research. Objectives: Our aim was to elicit the pregnant women's preferences for postpartum thromboprophylaxis according to different risks of venous thromboembolism (VTE) and bleeding. Methods: In 2 Swiss and French maternity hospitals, we conducted structured interviews of pregnant or postpartum women. Participants were instructed on pulmonary embolism, deep vein thrombosis, postpartum hemorrhage, and subcutaneous injections of low-molecular-weight heparin (LMWH). First, we randomized women to either standard gamble or time trade-off (2 different validated methods) to estimate the utilities (quality of life, from 0 to 1) of these health states. Second, we elicited the preference for the use of short-term postpartum thromboprophylaxis with LMWH vs none across different risks of postpartum VTE and bleeding through direct-choice exercises. Results: Among 122 participants, median (IQR) health state utilities were 0.725 (0.30-0.925) for pulmonary embolism, 0.75 (0.40-0.97) for postpartum hemorrhage, 0.85 (0.60-0.97) for deep vein thrombosis, and 0.96 (0.96-0.999) for LMWH injections. The median risk of postpartum VTE for preference of the use of postpartum thromboprophylaxis over no treatment was 0.1% (IQR, 0.01%-0.50%) without LMWH-associated bleeding risk and 0.2% (IQR, 0.1%-5%) with a 1% bleeding risk. Conclusion: European pregnant women appear to have a high willingness for 10-day postpartum thromboprophylaxis, preferred over no treatment even for low risks of postpartum VTE. This perspective from patients supports the urgent need for a randomized trial evaluating the efficacy and safety of postpartum thromboprophylaxis. Low-molecular-weight heparin Patient preference Postpartum period Pregnancy Venous thromboembolism Humans Female Adult Heparin, Low-Molecular-Weight / administration & dosage Heparin, Low-Molecular-Weight / adverse effects Heparin, Low-Molecular-Weight / therapeutic use Venous Thromboembolism / prevention & control Postpartum Period Anticoagulants / administration & dosage Anticoagulants / adverse effects Anticoagulants / therapeutic use Patient Preference Postpartum Hemorrhage / prevention & control Switzerland Risk Factors France Venous Thrombosis / prevention & control Quality of Life Pulmonary Embolism / prevention & control Hospitals, Maternity Risk Assessment Injections, Subcutaneous Dewey 616 Dewey 618 56 Département de médecine 221 58 Département de pédiatrie, gynécologie et obstétrique 223 false 477 Maladie thromboembolique veineuse 808 213 Martinez De Tejada Begona 272 Journal of thrombosis and haemostasis 22 10 883d0a55-fc6d-4b3a-8e83-8df673084e00 Article (Published version) Public 12.pdf 753618 application/pdf CC BY-4.0 abd3dd1f504d918edb0507cb1185c9ef360eab2b183da610ed631d451ab0e135 82b59b7f-116d-4527-93d9-226f83c5efab Supplemental data Public 1-s2.0-S1538783624003805-mmc1.docx 204065 application/vnd.openxmlformats-officedocument.wordprocessingml.document a57b33beaffad69ec562dbce142f6546fde752e16f5c438b791041ec04e5532c openAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique

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Preferences of pregnant women for postpartum thromboprophylaxis : the bicentric PREFER-PostPartum study	Journal of thrombosis and haemostasis			2024	102	228

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Bryan, Saskia Nadjezda Buxton