Risk of a thrombotic event after the 6-week postpartum period

Abstract

Background: The postpartum state is associated with a substantially increased risk of thrombosis. It is uncertain to what extent this heightened risk persists beyond the conventionally defined 6-week postpartum period.

Methods: Using claims data on all discharges from nonfederal emergency departments and acute care hospitals in California, we identified women who were hospitalized for labor and delivery between January 1, 2005, and June 30, 2010. We used validated diagnosis codes to identify a composite primary outcome of ischemic stroke, acute myocardial infarction, or venous thromboembolism. We then used conditional logistic regression to assess each patient's likelihood of a first thrombotic event during sequential 6-week periods after delivery, as compared with the corresponding 6-week period 1 year later.

Results: Among the 1,687,930 women with a first recorded delivery, 1015 had a thrombotic event (248 cases of stroke, 47 cases of myocardial infarction, and 720 cases of venous thromboembolism) in the period of 1 year plus up to 24 weeks after delivery. The risk of primary thrombotic events was markedly higher within 6 weeks after delivery than in the same period 1 year later, with 411 events versus 38 events, for an absolute risk difference of 22.1 events (95% confidence interval [CI], 19.6 to 24.6) per 100,000 deliveries and an odds ratio of 10.8 (95% CI, 7.8 to 15.1). There was also a modest but significant increase in risk during the period of 7 to 12 weeks after delivery as compared with the same period 1 year later, with 95 versus 44 events, for an absolute risk difference of 3.0 events (95% CI, 1.6 to 4.5) per 100,000 deliveries and an odds ratio of 2.2 (95% CI, 1.5 to 3.1). Risks of thrombotic events were not significantly increased beyond the first 12 weeks after delivery.

Conclusions: Among patients in our study, an elevated risk of thrombosis persisted until at least 12 weeks after delivery. However, the absolute increase in risk beyond 6 weeks after delivery was low. (Funded by the National Institute of Neurological Disorders and Stroke.).

Figure 1. Risk of a Thrombotic Event, According to the Interval after Delivery.

Shown are the results of a post hoc exploratory analysis of the risk of a composite primary outcome of ischemic stroke, acute myocardial infarction, or venous thromboembolism across sequential 3-week periods after labor and delivery, as compared with each patient's risk during the same period 1 year later. The thrombotic risk was still increased during the period of 13 to 15 weeks after delivery (odds ratio, 2.0; 95% CI, 1.1 to 3.6) but was no longer elevated in the period of 16 to 18 weeks after delivery (odds ratio, 1.0; 95% CI, 0.6 to 1.8). The vertical lines indicate 95% confidence intervals.