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During pregnancy a woman’s risk of venous thromboembolism (VTE) is five to tenfold higher than during her nonpregnancy state.1 In fact, thromboembolic disease is one of the leading causes of obstetric mortality.2 The increased risk persists into the postpartum period and rises further during this time.3 The postpartum period is defined as the 6 weeks after delivery.1 The American College of Chest Physicians (ACCP) recommends continuing with anticoagulants for at least 6 weeks postpartum for the following: selected high-risk patients in which risk factors persist after delivery, women with acute VTE, or women with prior VTE.1

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Kamel and colleagues performed a retrospective crossover-cohort study to assess if the duration of increased postpartum thrombotic risk persists beyond the 6-week period.3 Study patients were identified through hospitalization records in California based on ICD-9 codes for labor and delivery. Exclusion of study subjects occurred if they were non-California residents, less than 12 years of age, cases of false labor, patients who had any thrombosis diagnoses before their first recorded delivery, patients with a second delivery during the follow-up period, and patients in whom it was not their first pregnancy. The study compared each patient’s risk of a thrombotic event during the first 6 weeks after delivery compared with the risk of an event during the same 6 weeks one year later. In addition, the study authors conducted the analysis for each patient for postpartum days 42 through 83, 84 through 125, and 126 through 167. The primary outcome was a composite of ischemic stroke, acute myocardial infarction, or venous thromboembolism.The study authors hypothesized that the risk would progressively decrease but would remain significantly elevated through 12 weeks after delivery.3

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A total of 1,687,930 patients were identified during the study period with a first recorded hospitalization for labor and delivery. A total of 1,015 women had a thrombotic event (248 cases of stroke, 47 cases of myocardial infarction, 720 cases of VTE) in the first year and 24 weeks postpartum. Some risk factors identified for having a thrombotic event include: older age (> 35 yo), white or black race, and not privately insured. There were 411 thrombotic events within the first 6 weeks after delivery compared to 38 events for the same period 1 year later, absolute risk difference of 22.1 (95% confidence interval [CI] 19.6 to 24.6) per 100,000 deliveries with an odds ratio of 10.8 (95% CI, 7.8 to 15.1). For weeks 7-12 post delivery there were 95 events compared to 44 events for the same time period 1 year later, absolute risk difference of 3.0 (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). After week 12 the risk was no longer significantly elevated with an odds ratio of 1.4 for weeks 13-18, and an odds ratio of 1.0 for weeks 19-24. Women who had undergone a cesarean section rather than a vaginal delivery did ...

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