Danny Hsu: Are We Underestimating Postpartum VTE Risk?
Danny Hsu, President of THANZ, Director of Therapeutic Apheresis, Immune and Obstetric Haematology at South Western Sydney Local Health District, shared JTH’s post on LinkedIn about a recent article by Eloïse Laouenan et al. published in JTH, adding:
“Are we underestimating postpartum VTE risk?
A vital new read for our International Society on Thrombosis and Haemostasis (ISTH) and HOW Collaborative communities!
The prospective HEMOTHEPP cohort study has just published some eye-opening data on venous thromboembolism (VTE) incidence in pregnancy and the postpartum period.
If we are going to optimize health outcomes for women, we need precise data on when these events occur and who is truly at risk. Here are the standout findings from this more than 20,000 patient cohort:
- Incidence is double what was expected: Postpartum VTE hit 4.9 per 1000 person-years (compared to 1.3 during pregnancy).
- Timing is crucial: A striking 60% of postpartum VTEs occurred between days 8 and 42 – well after that first week.
- The Prophylaxis Gap: Despite nearly 40% of women meeting RCOG criteria for intermediate or high risk, only 39.6% of those eligible actually received thromboprophylaxis.
- The Efficacy Question: Most surprisingly, for intermediate-risk women, VTE incidence was virtually identical with or without prophylaxis (12.0 vs 11.8 per 1000 person-years).
This data is a massive wake-up call.
It highlights a clear underprescription of postpartum thromboprophylaxis, but also strongly signals a need for robust randomized trials to truly evaluate the benefit of our current strategies – especially for intermediate-risk patients (I have always struggled with this cohort as in my region high BMI makes majority of the patients I see intermediate-risk).
What are your thoughts on this data?
Do we need to fundamentally rethink our risk stratification and prophylaxis models in obstetrics? Let’s discuss!”
Journal of Thrombosis and Haemostasis (JTH) shared a post on LinkedIn:
“Epidemiology of Venous Thromboembolism During Pregnancy and Postpartum: Results from the French Prospective Multicenter HEMOTHEPP Study
In over 20,000 women, postpartum VTE incidence was twice the expected rate, thromboprophylaxis was significantly underprescribed, and its effectiveness in intermediate-risk women remains uncertain — underscoring an urgent need for targeted randomized trials.”
Title: Epidemiology of venous thromboembolism during pregnancy and postpartum: results from the French prospective multicenter HEMOrrhage and venous THromboEmbolism in PostPartum study
Authors: Eloïse Laouenan, François Anouilh, Emmanuelle Courtois-Communier, Claire de Moreuil, Sara Robin, Ségolène Le Reun, Karine Morcel, Matthieu Jacquot, Violaine Bellec, Matthieu Muller, Christophe Tremouilhac, Nathalie Touffet, Caroline Cornec, Guillaume Drugmanne, Cécile Tromeur, Dominique Mottier, Karine Lacut, Raphaël Le Mao, Benjamin Espinasse, Gisèle Marhic, Catherine A. Lemarié, Grégoire Le Gal, Christophe Leroyer, Francis Couturaud, Brigitte Pan-Petesch, Emmanuelle Le Moigne
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