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Future Thromboembolism Risk From Pre-Eclampsia

Women who have had pre-eclampsia run a small but significantly higher risk of future venous thromboembolism when compared with women who had other common obstetrical diseases, Canadian researchers have found.

The study by Dr Carl van Walraven and colleagues at the Ottawa Health Research Institute, Ontario, Canada, compared 12,849 women admitted to hospital with pre-eclampsia and 284,188 controls. All of the women were observed for up to three years after discharge from hospital.

Pre-eclampsia is associated with occlusion of the placental spiral arteries, the researchers point out. Thrombophilias may cause thrombosis of placental vessels, and this could explain the link with pre-eclampsia. This led them to test the hypothesis that women with pre-eclampsia have a higher risk of subsequent venous thromboembolism.

It was found that venous thromboembolism was more common in the pre-eclampsia group (0.12%, 41.7 events per 100 000 person years observation) than in any of the control groups (range 0.01 to 0.08%, rates of 3.0 to 33.8 events per 100 000 person years observation).

The researchers used proportional hazards modelling to control for patient age and caesarean section, and showed that, compared with all control groups combined, women with pre- eclampsia were 2.2 times more likely (95% confidence interval 1.3 to 3.7) to be admitted to hospital with venous thromboembolism.

They conclude: "Our results support the association between pre-eclampsia and thrombophilia."

"The absolute risk increase with pre-eclampsia is too small to warrant venous thromboembolism prophylaxis for such patients. The signs and symptoms of venous thromboembolism should be reviewed with women who develop or have had pre- eclampsia so that they can seek appropriate medical care if the need arises."
BMJ 2003;326:791-2.

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