PB1524 - Preferences of pregnant women for postpartum thromboprophylaxis: the bicentric PREFER-PP study

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Marc Blondon, MD MS (he/him/his)

MD
Division of Angiology and Hemostasis, Geneva University Hospitals
Geneva, Geneve, Switzerland

Co-Author(s)

ML

Maud Lansiaux

MD
Gynecology department, Gynaecological Endocrinology Unit, Hospital Saint Joseph, Paris, France
Paris, Ile-de-France, France
SB

Saskia Bryan

Medical student
Faculty of Medicine, Geneva, Switzerland
Geneva, Geneve, Switzerland
AD

Amélie Dongala

MD
Gynecology department, Gynaecological Endocrinology Unit, Hospital Saint Joseph, Paris, France
Paris, Ile-de-France, France
RP

Romain Pavoncello

Medical student
Faculty of Medicine, Geneva, Switzerland
Geneva, Geneve, Switzerland
MC

Marine Claver

MD
Department of Paediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, University Hospitals of Geneva
Geneva, Geneve, Switzerland
EA

Elie Azria

MD
Maternity Unit, Groupe Hospitalier Paris Saint Joseph, Paris
Paris, Ile-de-France, France
BM

Begoña Martinez de Tejada

MD
Department of Paediatrics, Gynecology and Obstetrics, University Hospitals of Geneva
Geneva, Geneve, Switzerland
Justine Hugon-Rodin, MD PhD (she/her/hers)

Gynecology department, Gynaecological Endocrinology Unit, Hospital Saint Joseph, Paris Division of Gynecology, University Hospitals of Geneve, Geneva, Switzerland
Paris, Ile-de-France, France

Background: Clinical guidelines for postpartum thromboprophylaxis differ considerably, due to uncertainties of its effect, an overall low risk of venous thromboembolism (VTE) and varying preferences of experts. The preferences of pregnant women for postpartum thromboprophylaxis may help inform practices and future clinical trials, but have never been elicited.

Aims: To estimate the quality-of-life of relevant health conditions and to elicit the preference of pregnant women for postpartum thromboprophylaxis, according to different risks of VTE and bleeding.

Methods: In 2 European maternities, we conducted structured interviews of pregnant or postpartum women. Clinical vignettes instructed on the symptoms, signs or burden associated with pulmonary embolism (PE), deep vein thrombosis (DVT), obstetrical bleeding and subcutaneous injections of low-molecular-weight heparin (LMWH). First, we estimated their utilities (quality-of-life, ranging from 0-1) by the standard gamble or the time trade-off method. Second, we elicited the minimum VTE risk to prefer the use of a short-term postpartum thromboprophylaxis with LMWH, over its non-use, without and with an accrued bleeding risk. Electronic visual aids were used to facilitate understanding.

Results: Among 122 participants, 49 (40.2%) and 73 (59.8%) were in the antenatal and postpartum period respectively. From lowest to highest, median (IQR) health states utilities ranked as: PE (0.725, 0.3-0.925), obstetrical bleeding (0.75, 0.4-0.97), DVT (0.85, 0.6-0.97) and subcutaneous injection of LMWH (0.96, 0.96-0.9995). The median risk of postpartum VTE to prefer the use of postpartum thromboprophylaxis over no treatment was 0.1% (IQR 0.01-0.5%) without LMWH-associated bleeding risk and 0.2% (IQR 0.1-5%) with a 1% bleeding risk.

Conclusion(s): The quality of life of VTE and bleeding valued by pregnant women is similar as in previous reports from non-pregnant populations. Pregnant women have a high willingness for postpartum thromboprophylaxis, preferred to no treatment event at low risks of postpartum VTE, despite the consequent high number needed to treat to prevent a VTE event.