Current practice patterns of outpatient management of acute pulmonary embolism: A post-hoc analysis of the YEARS study

Background: Studies have shown the safety of home treatment of patients with pulmonary embolism (PE) at low risk of adverse events. Management studi

Venous thromboembolism in pregnancy: Prevention, diagnosis and long-term outcomes

The thesis covers the clinical approach of venous thromboembolism (VTE) in pregnancy. Pregnancy is a risk factor for VTE and accountable for up to 30% of VTE in women younger than 45 years. During pregnancy, risk of VTE is increased due to prothrombotic hemostatic changes, stasis of blood flow as a result of pressure of the gravid uterus and vessel wall damage during delivery. In absolute terms, one to two in 1,000 pregnancies is complicated by VTE. Women with a personal history of VTE especially are at high risk of recurrent thrombosis during a subsequent pregnancy. In the first part of the thesis we focus on the prevention of VTE in pregnancy and the postpartum period. We describe the results of the Highlow study. In this large open-label, multicenter, randomized, controlled trial we compared a weight-adjusted intermediate-dose low-molecular-weight heparin (LMWH) to a fixed low-dose LMWH for the prevention of a pregnancy-related recurrence. Other subjects discussed in this part included the safety of inferior vena cava filters in pregnant patients and the exposure of direct oral anticoagulants in pregnancy. In the second part of the thesis, we describe the diagnostic management of pulmonary embolism and deep-vein thrombosis (DVT) during pregnancy in the Artemis study. In this prospective management study, the pregnancy-adapted YEARS algorithm enables physicians to safely rule-out pulmonary embolism without CT-scanning in 40% of pregnant patients in whom this diagnosis is suspected. In the third part of the thesis we address the long-term outcomes of VTE such as post-thrombotic syndrome and quality of life after VTE

Venous thromboembolism in pregnancy: Prevention, diagnosis and long-term outcomes

The thesis covers the clinical approach of venous thromboembolism (VTE) in pregnancy. Pregnancy is a risk factor for VTE and accountable for up to 30% of VTE in women younger than 45 years. During pregnancy, risk of VTE is increased due to prothrombotic hemostatic changes, stasis of blood flow as a result of pressure of the gravid uterus and vessel wall damage during delivery. In absolute terms, one to two in 1,000 pregnancies is complicated by VTE. Women with a personal history of VTE especially are at high risk of recurrent thrombosis during a subsequent pregnancy. In the first part of the thesis we focus on the prevention of VTE in pregnancy and the postpartum period. We describe the results of the Highlow study. In this large open-label, multicenter, randomized, controlled trial we compared a weight-adjusted intermediate-dose low-molecular-weight heparin (LMWH) to a fixed low-dose LMWH for the prevention of a pregnancy-related recurrence. Other subjects discussed in this part included the safety of inferior vena cava filters in pregnant patients and the exposure of direct oral anticoagulants in pregnancy. In the second part of the thesis, we describe the diagnostic management of pulmonary embolism and deep-vein thrombosis (DVT) during pregnancy in the Artemis study. In this prospective management study, the pregnancy-adapted YEARS algorithm enables physicians to safely rule-out pulmonary embolism without CT-scanning in 40% of pregnant patients in whom this diagnosis is suspected. In the third part of the thesis we address the long-term outcomes of VTE such as post-thrombotic syndrome and quality of life after VTE

Sex-specific performance of pre-imaging diagnostic algorithms for pulmonary embolism

Thrombosis and Hemostasi

Onset of labor and use of analgesia in women using thromboprophylaxis with 2 doses of low-molecular-weight heparin: insights from the Highlow study.

BACKGROUND: Peripartum management of women using low-molecular-weight heparin (LMWH) varies widely. Minimum time intervals are required between LMWH injection and neuraxial procedure, and they differ by dose. OBJECTIVES: The objective of this study was to describe the onset of labor and use of analgesia in women using LMWH and to compare practices between intermediate-dose and low-dose LMWH. METHODS: In the Highlow study (NCT01828697), 1110 women were randomized to intermediate-dose or low-dose LMWH and were instructed to discontinue LMWH when labor commenced unplanned or 24 hours prior to planned delivery. The required time interval since last injection to receive a neuraxial procedure was ≥24 hours for intermediate-dose LMWH or ≥12 hours for low-dose LMWH. RESULTS: In total, 1018 women had an ongoing pregnancy for ≥24 weeks. Onset of labor was spontaneous in 198 of 509 (39%) women on intermediate-dose LMWH and in 246 of 509 (49%) on low-dose LMWH. With unplanned onset, a neuraxial procedure was performed in 37% on intermediate-dose and in 48% on low-dose LMWH (risk difference -11%, 95% CI -20% to -2%). Based on time interval, 61% on intermediate-dose and 82% on low-dose LMWH were eligible for a neuraxial procedure. With planned onset, 68% on intermediate-dose and 66% on low-dose LMWH received a neuraxial procedure, whereas 81% and 93%, respectively, were eligible for a neuraxial procedure (risk difference -13%, 95% CI -18% to -8%). CONCLUSION: With spontaneous onset of labor, neuraxial procedures were performed less often in women using intermediate-dose LMWH. Irrespective of onset, fewer women on intermediate-dose LMWH than those on low-dose LMWH were eligible for neuraxial procedures based on required time intervals since the last LMWH injection