Comparison and Validation of Different Risk Assessment Models in Patients with Venous Thromboembolism During Pregnancy and Postpartum: A Retrospective Study in China

Abstract

Introduction

Venous thromboembolism (VTE) causes maternal mortality and morbidity. This study compares the predictive performance of three risk assessment models (Caprini model, Wells Score, and RCOG model) for VTE risk in Chinese patients during pregnancy and postpartum.

Materials and Methods

We conducted a retrospective study in Nanfang Hospital of Southern Medical University and the Third Affiliated Hospital of Guangzhou Medical University from January 2003 to January 2022. Patients were risk-classified using the three risk assessment models, and the models were evaluated for accuracy.

Results

A total of 302 patients with confirmed VTE during pregnancy and postpartum were identified. Of these, 142 (47.0%) were diagnosed during pregnancy and 160 (53.0%) postpartum. A total of 276 (91.4%) patients had DVT only, 14 (4.6%) had PE only, and 12 (4.0%) were diagnosed with both. Of the 142 antepartum patients, 140 were categorized at moderate or above-risk levels by the Caprini model, 134 in the Wells Score model, and 112 in the RCOG model, respectively. The number of postpartum patients at moderate or above-risk levels identified by the Caprini, Wells Score, and RCOG models were 160, 152, and 118. The Caprini model significantly stratified VTE patients into a moderate or high-risk level (p < 0.05, Friedman Test). The Caprini model was also more effective at assessing the risk of VTE among postpartum patients than antepartum patients (p < 0.05, Friedman Test).

Conclusion

We have demonstrated that the Caprini model is an effective prediction tool for the maternal population during peripartum, especially in the postpartum period. Results from the Caprini model will help obstetricians or physicians stratify potential risk patients and guide prophylaxis decisions. The RCOG model was not particularly useful in Chinese VTE patients during pregnancy and postpartum. Multicenter prospective validations of the RCOG model in Chinese maternal populations are needed.

Keywords:

• venous thromboembolism
• deep venous thrombosis
• pulmonary embolism
• risk assessment models
• pregnancy and postpartum
• antepartum and postpartum

Abbreviations

VTE, venous thromboembolism; DVT, deep venous thrombosis; PE, pulmonary embolism; RAMs, risk assessment models; BMI, body mass index; RCOG, Royal College of Obstetricians and Gynecologists.

Data Sharing Statement

All data generated or analyzed during this study are included in this published article.

Ethics Approval and Informed Consent

This study was performed in line with the principles of the Declaration of Helsinki. The Ethics Committee of Nanfang Hospital of Southern Medical University and the Third Affiliated Hospital of Guangzhou Medical University approved. Informed consent was obtained from all individual participants included in the study.

Acknowledgments

We greatly acknowledge the collaboration received from the staff of the Medical Records Department of Nanfang Hospital of Southern Medical University and the Third Affiliated Hospital of Guangzhou Medical University. This study was performed at Nanfang Hospital of Southern Medical University and Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The study is supported by the Health Appropriate Technology Promotion Project of Guangdong Province (No.202206280010517553), the Health Science and Technology Project of Guangzhou (No.20231A010057), and the Research Project of Population and Family Planning Commission of Guangdong Province, China (No. 20110330).