Abstract
Purpose
Women with a history of prior venous thromboembolism have an increased risk for recurrence
during pregnancy. Although thromboprophylaxis reduces this risk, recent evidence suggests
that, in many cases, prophylaxis can be safely withheld because the estimated recurrence
risk is very low. The balance of risks and benefits in women with different recurrence
risks has not been examined.
Methods
We developed a Markov state transition decision analytic model to compare prophylactic
low molecular weight heparin to expectant management for pregnant women with a single
prior venous thromboembolism. A lifetime time horizon and societal perspective were
assumed. Input data were obtained by literature review. Outcomes were expressed as
U.S. dollars per quality-adjusted life-year (QALY).
Results
For “low-risk” women with a prior venous thromboembolism associated with a transient
risk factor and no known thrombophilic condition (recurrence risk 0.5%), expectant
management was both more effective and less costly than prophylaxis. For “high-risk”
women with prior idiopathic venous thromboembolism or known thrombophilic condition
(recurrence risk 5.9%), prophylaxis was associated with a reasonable cost-effectiveness
ratio ($38,700 per QALY) given a risk of bleeding complications <1.0% (base case 0.5%).
Conclusion
For low-risk women with prior venous thromboembolism, expectant management during
pregnancy leads to better outcomes than administration of prophylactic low molecular
weight heparin. For high-risk women, antepartum thromboprophylaxis is a cost-effective
use of resources.
Keywords
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Article info
Publication history
Accepted:
May 26,
2004
Received in revised form:
May 26,
2004
Received:
July 30,
2003
Footnotes
This study was conducted while Dr. Johnston was a research fellow at the University of Cincinnati Medical Center.
Identification
Copyright
© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
