Preferences of pregnant women for postpartum thromboprophylaxis: the bicentric PREFER-PostPartum study
Marc Blondon 1), Maud Lansiaux 2), Saskia Bryan 3), Amélie Dongala 2), Romain Pavoncello 3), Gilles Chatellier 4), Marine Claver 5), Elie Azria 6)7), Begoña Martinez de Tejada 5), Justine Hugon-Rodin 8)9)
1 – Division of Angiology and Hemostasis, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
2 – Gynecology Department, Gynaecological Endocrinology Unit, Hospital Saint Joseph, Paris, France
3 – Faculty of Medicine, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
4 – Clinical Research Unit, Paris Saint Joseph Hospital, Paris, France
5 – Division of Obstetrics, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
6 – Maternity Unit, Paris Saint Joseph Hospital, Fédération Hospitalo-Universitaire Combattre la prématurité, Paris, France
7 – Université de Paris Cité, Centre de Recherche en Epidémiologie et Statistiques, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Equipe de recherche en épidémiologie obstétricale périnatale et pédiatrique, Institut national de la santé et de la recherche médicale, Paris, France
8 – Gynecology Department, Gynaecological Endocrinology Unit, Hospital Saint Joseph, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, France
9 – Division of Gynecology, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
Abstract
Background
Clinical guidelines for postpartum thromboprophylaxis differ due to its uncertain effect and varying preferences of experts. Women’s preferences for postpartum thromboprophylaxis are unknown, although they may inform practices and future research.
Objectives
Our aim was to elicit the pregnant women’s preferences for postpartum thromboprophylaxis according to different risks of venous thromboembolism (VTE) and bleeding.
Methods
In 2 Swiss and French maternity hospitals, we conducted structured interviews of pregnant or postpartum women. Participants were instructed on pulmonary embolism, deep vein thrombosis, postpartum hemorrhage, and subcutaneous injections of low-molecular-weight heparin (LMWH). First, we randomized women to either standard gamble or time trade-off (2 different validated methods) to estimate the utilities (quality of life, from 0 to 1) of these health states. Second, we elicited the preference for the use of short-term postpartum thromboprophylaxis with LMWH vs none across different risks of postpartum VTE and bleeding through direct-choice exercises.
Results
Among 122 participants, median (IQR) health state utilities were 0.725 (0.30-0.925) for pulmonary embolism, 0.75 (0.40-0.97) for postpartum hemorrhage, 0.85 (0.60-0.97) for deep vein thrombosis, and 0.96 (0.96-0.999) for LMWH injections. The median risk of postpartum VTE for preference of the use of postpartum thromboprophylaxis over no treatment was 0.1% (IQR, 0.01%-0.50%) without LMWH-associated bleeding risk and 0.2% (IQR, 0.1%-5%) with a 1% bleeding risk.
Conclusion
European pregnant women appear to have a high willingness for 10-day postpartum thromboprophylaxis, preferred over no treatment even for low risks of postpartum VTE. This perspective from patients supports the urgent need for a randomized trial evaluating the efficacy and safety of postpartum thromboprophylaxis.