[Maternal mortality due to venous thromboembolism in France 2013-2015]

Venous Thromboembolism Risk Score and Pregnancy

Venous thromboembolism (VTE) is a major contributor to maternal morbidity and mortality worldwide. Pregnancy is associated with the development of a baseline hypercoagulable state. The two strongest risk factors for pregnancy-associated VTE are previous VTE and/or high risk thrombophilia. The others risk factors for VTE during pregnancy are well known such as maternal, pregnancy and delivery characteristics. Considering the variation in recommendation in guidelines and low-quality evidence on the prevention, diagnosis and treatment, practice differs between countries and clinical institutions. Some authors developed risk scores, enabling individualized estimation of thrombotic risk during pregnancy, and permitting implementation of a risk-adapted strategy for thromboprophylaxis during pregnancy and postpartum. This review describes the existing VTE risk scores during the antenatal and postnatal period. The important message beyond the score used is that all women should undergo VTE risk factor assessment. The use of a Computerized Clinical Decision Support System for VTE risk assessment should be explored in obstetrics.

Global reporting of pulmonary embolism-related deaths in the World Health Organization mortality database: Vital registration data from 123 countries

Introduction

Pulmonary embolism (PE) has not been accounted for as a cause of death contributing to cause‐specific mortality in global reports.

Methods

We analyzed global PE‐related mortality by focusing on the latest year available for each member state in the World Health Organization (WHO) mortality database, which provides age‐sex–specific aggregated mortality data transmitted by national authorities for each underlying cause of death. PE‐related deaths were defined by International Classification of Diseases, Tenth Revision codes for acute PE or nonfatal manifestations of venous thromboembolism (VTE). The 2001 WHO standard population served for standardization.

Results

We obtained data from 123 countries covering a total population of 2 602 561 422. Overall, 50 (40.6%) were European, 39 (31.7%) American, 13 (10.6%) Eastern Mediterranean, 13 (10.6%) Western Pacific, 3 (2.4%) Southeast Asian, and 2 (1.6%) African. Of 116 countries classifiable according to population income, 57 (49.1%) were high income, 42 (36.2%) upper‐middle income, 14 (12.1%) lower‐middle income, and 3 (2.6%) low income. A total of 18 726 382 deaths were recorded, of which 86 930 (0.46%) were attributed to PE. PE‐related mortality rate increased with age in most countries. The reporting of PE‐related deaths was heterogeneous, with an age‐standardized mortality rate ranging from 0 to 24 deaths per 100 000 population‐years. Income status only partially explained this heterogeneity.

Conclusions

Reporting of PE‐related mortality in official national vital registration was characterized by extreme heterogeneity across countries. These findings mandate enhanced efforts toward systematic and uniform coverage of PE‐related mortality and provides a case for full recognition of PE and VTE as a primary cause of death.