Use of the Delphi method to facilitate antithrombotics prescription during pregnancy

Abstract 

Introduction

Management of pregnant women at risk for venous thromboembolism (VTE) remains complex. Guidelines do not definitively fix optimal strategies due to limited trial data. Our objective was to build an easy-to-use tool allowing individualised, risk-adapted prophylaxis.

Materials and Methods

A Delphi exercise was conducted to collect 19 French experts’ opinions on pregnancy-related VTE.

Results

Experts with an active interest in clinical research and care of VTE and placental vascular complications were selected. The risk score was classified by an anonymous computer vote. A scoring system for VTE risk in pregnant women was developed, each score being associated with a specific treatment: graduated elastic compression stockings, aspirin, prophylactic Low Molecular Weight Heparin (LMWH: variable durations), or adjusted-dose of LMWH through pregnancy and postpartum.

Conclusions

Our simple consensual scoring system offers an individual estimation of thrombosis risk during pregnancy together with its related therapeutic strategy, in accordance with most of the new international recommendations. The accuracy of our individual risk score-based therapeutic guidance is currently being prospectively evaluated in a multicenter trial (Clinicaltrials.gov registry no: NCT00745212).

Abbreviations: ACA, anticardiolipin antibodies, ACCP, American College of Chest Physicians, aPL, positive anticardiolipin or anti-β2-glycoprotein 1 antibodies, AT, antithrombin deficiency, BID, twice daily, CI, confidence interval, DVT, deep-vein thrombosis, IUFD, intrauterine foetal death, IUGR, intrauterine growth restriction, LMWH, low-molecular-weight heparin, PVC, placental vascular complications, PE, pulmonary embolism, UFH, unfractionated heparin, VTE, venous thromboembolism

Keywords: Pregnancy, Venous thromboembolism, Risk score, Guidelines, Risk assessment