|
|
|
| The clinical value of Caprini model in predicting postpartum venous thrombosis in elderly parturients |
| CHEN Jie, HUANG Hao |
| Obstetrics and Gynecology, the First Clinical Medical College of Guangdong Medical University, Zhanjiang 524000 |
|
|
|
|
Abstract Objective To investigate the validity and clinical value of Caprini model in predicting the occurrence of venous thromboembolism (VTE) in advanced maternal age (AMA). Methods A retrospective case study was conducted to select 35 AMAs born in our center from January 2020 to October 2023 with postpartum diagnosis of VTE as the obervation group, and 70 AMAs born in our center during the same period with postpartum diagnosis of non-VTE as the control group according to the principle of 1: 2. Various clinical data of the two groups of patients were collected, and then the Caprini venous thrombosis risk prediction model was used to score various risk items for the two groups of patients. The differences in Caprini score between the two groups were compared by T-test, and the risk factors and risk stratification under this model were evaluated by Chi-square test and Logistic regression analysis. The independent risk factors of postpartum VTE and the relationship between risk stratification and the risk of VTE were analyzed. Results The average Caprini score of the observation group was significantly higher than that of the control group. Based on the single factor analysis of Caprini model entries, there is no statistically significant difference in six factors: bed time, abnormal lung function, family history of VTE, history of abortion (including unknown cause or habitual), history of inflammatory bowel, and laparoscopic surgery ; Patients in the observation group had a higher proportion in age over 40 years old, central venous access indentation, minor surgery, major open surgery, leg swelling, varicose veins, and history of VTE disease ; The observation and control groups were not comparable in terms of BMI, severe lung disease, malignancy, oral contraceptives or estrogen, and pregnancy or 1 month postpartum. Logistic analysis results showed that indentable central venous access, leg swelling, and varicose veins were independent risk factors for VTE in advanced maternal age. Conclusion Caprini venous thrombosis risk prediction model can effectively stratification the perinatal risk of VTE in elderly women. When patients have central venous access indentation, leg swelling, and varicose veins, it indicates that the risk of perinatal VTE in elderly women will increase significantly, this study provides a new scientific clue for the prevention and treatment of perinatal VTE in advanced maternal age.
|
|
Received: 28 April 2024
|
|
|
|
|
|
[1] ABBOUD J, ABDEL RAHMAN A, KAHALE L, et al.Prevention of health care associated venous thromboembolism through implementing VTE prevention clinical practice guidelines in hospitalized medical patients: a systematic review and meta-analysis[J]. Implement Sci, 2020, 15(1) : 49.
[2] CORLEY A, ROYLE RH, MARSH N, et al.Incidence and risk factors for central venous access device failure in hospitalized adults: A multivariable analysis of 1892 catheters[J]. J Hosp Med, 2024, 19(10) : 905-917.
[3] BATES SM, GREER IA, MIDDELDORP S, et al.VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J]. Chest, 2012, 141(2 Suppl) : e691S-e736S.
[4] BUTWICK AJ, BENTLEY J, LEONARD SA, et al.Prepregnancy maternal body mass index and venous thromboembolism: a population-based cohort study[J]. BJOG, 2019, 126(5) : 581-588.
[5] XING L, BAI T, LIU S, et al.Maternal, neonatal, pregnancy outcome characteristics of pregnant women with high plasma cell-free DNA concentration in non-invasive prenatal screening: a retrospective analysis[J]. Front Pediatr, 2023, 11: 1195818.
[6] LARSEN TB, SØRENSEN HT, GISLUM M, et al. Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study[J]. Thromb Res, 2007, 120(4) : 505-509.
[7] VINCENTELLI GM, TIMPONE S, MURDOLO G, et al.A new risk assessment model for the stratification of the thromboembolism risk in medical patients: the TEVere Score[J]. Minerva Med, 2018, 109(6) : 436-442.
[8] GOULD MK, GARCIA DA, WREN SM, et al.Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J]. Chest, 2012; 141(2) : e227S-e277S.
[9] ZHANG X, HAO A, LU Y, et al.Deep vein thrombosis and validation of the Caprini risk assessment model in Chinese orthopaedic trauma patients: a multi-center retrospective cohort study enrolling 34, 893 patients[J]. Eur J Trauma Emerg Surg, 2023, 49(4) : 1863-1871.
[10] MARTIN JA, HAMILTON BE, OSTERMAN MJK, et al.Births: Final Data for 2015[J]. Natl Vital Stat Rep, 2017, 66(1) : 1.
[11] WILLIAMS A, LITTLE SE, BRYANT AS, et al.Mode of Delivery and Unplanned Cesarean: Differences in Rates and Indication by Race, Ethnicity, and Sociodemographic Characteristics[J]. Am J Perinatol, 2024, 41(7) : 834-841.
[12] KAVEH M, GHAJARZADEH M, TANHA DF, et al.Pregnancy Complications and Neonatal Outcomes in Multiple Pregnancies: A Comparison between Assisted Reproductive Techniques and Spontaneous Conception[J]. Int J Fertil Steril, 2015, 8(4) : 367-372.
[13] MARKFELD E F, ALENA HÄUßLER J, MEDL M, et al. Placenta Accreta Spectrum (PAS) : Diagnosis, Clinical Presentation, Therapeutic Approaches, and Clinical Outcomes[J]. Medicina (Kaunas) , 2024, 60(7): 1180.
[14] ATAYA A, FARUQI I, SALGADO JC.A 41-year-old woman with shortness of breath and history of rash and recurrent laryngeal edema[J]. Chest , 2015, 147(2) : e44-e47.
[15] HASEGAWA J, SEKIZAWA A, TANAKA H, et al.Current status of pregnancy-related maternal mortality in Japan: a report from the Maternal Death Exploratory Committee in Japan[J]. BMJ Open, 2016, 6(3) : e010304.
[16] MOADDAB A, CHERVENAK FA, MCCULLOUGH LB, et al.Effect of advanced maternal age on maternal and neonatal outcomes in assisted reproductive technology pregnancies[J]. Eur J Obstet Gynecol Reprod Biol, 2017; 216: 178-183.
[17] ARAKAKI D, IWATA M, TERASAWA T.External Validation of the Padua and IMPROVE-VTE Risk Assessment Models for Predicting Venous Thromboembolism in Hospitalized Adult Medical Patients: A Retrospective Single-Center Study in Japan[J]. Ann Vasc Dis, 2023, 16(1) : 60-68.
[18] 危玲, 陈奕. 妊娠期及产褥期静脉血栓栓塞症风险评估及预防[J]. 现代妇产科进展, 2021, 30(5) : 330-334.
[19] ISMAIL A, JADAWJI N, ADEBAYO P, et al.Evaluation of venous thromboembolism (VTE) risk assessment and thrombo-prophylaxis practices in hospitalized medical and surgical patients at Aga Khan Hospital Dar es Salaam: single-centre retrospective study[J]. Pan Afr Med J, 2022, 42: 160.
[20] STREIFF MB.Predicting the risk of recurrent venous thromboembolism (VTE)[J]. J Thromb Thrombolysis, 2015, 39(3) : 353-366.
[21] MELIS F, VANDENBROUKE JP, BÜLLER HR, et al. Estimates of risk of venous thrombosis during pregnancy and puerperium are not influenced by diagnostic suspicion and referral basis[J]. Am J Obstet Gynecol, 2004, 191(3) : 825-829.
[22] NAM KH, KWON JY, KIM YH, et al.Pregnancy outcome after cervical conization: risk factors for preterm delivery and the efficacy of prophylactic cerclage[J]. J Gynecol Oncol, 2010, 21(4) : 225-229.
[23] PANELLI DM, PHILLIPS CH, BRADY PC.Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review[J]. Fertil Res Pract, 2015, 1: 15.
[24] TIPERNENI R, RAJAMOHAN A, PADAPPAYIL RPP, et al.Blood Being Tricky: Anticoagulation-Resistant Venous Thromboembolism (VTE)[J]. Cureus, 2022, 14(6) : e25914. |
|
|
|
2024, Vol. 21 
