Background Few data are available on thrombotic outcomes during pregnancy and puerperium occurring after an initial provoked venous thromboembolic (VTE) event. Objectives To describe thrombotic outcomes during pregnancy after a first combined oral contraceptive (COC)-associated VTE and the factors associated with recurrence. Methods This was an international multicentric retrospective study on patients referred for thrombophilia screening from January 1, 2010 to January 1, 2021 following a first COC-associated VTE, including women with neither inherited thrombophilia nor antiphospholipid antibodies and focusing on those who had a subsequent pregnancy under the same thromboprophylaxis treatment. Thrombotic recurrences during pregnancy and puerperium as well as risk factors for recurrence were analyzed. Results We included 2,145 pregnant women. A total of 88 thrombotic events, 58 antenatal and 29 postnatal, occurred, mostly during the first trimester of pregnancy and the first 2 weeks of puerperium. Incidence rates were 49.6 (37–62) per 1,000 patient-years during pregnancy and 118.7 (78–159) per 1,000 patient-years during puerperium. Focusing on pulmonary embolism, incidence rates were 1.68 (1–4) per 1,000 patient-years during pregnancy and 65.5 (35–97) per 1,000 patient-years during puerperium.Risk factors for antenatal recurrences were maternal hypercholesterolemia and birth of a very small-for-gestational-age neonate. A risk factor for postnatal recurrence was the incidence of preeclampsia. Conclusion Our multicentric retrospective data show significant rates of VTE recurrence during pregnancy and puerperium in women with a previous VTE event associated with COC, despite a unique low-molecular-weight heparin-based thromboprophylaxis. These results may provide benchmarks and valuable information for designing future randomized controlled trials.

Objective: To study the association between high activity of Factor II (prothrombin) in blood plasma with G20210A mutation and the development of great obstetrical syndromes. Material and methods: A prospective clinical cohort study was conducted on 290 pregnant women (average age 31.7 ± 4.7 years old). The main group was made up of 140 G20210A patients, while the control group comprised 150 women with the wild G20210G type. The aim was to evaluate the activity of Factor II in the venous blood plasma during the stages of pregnancy with regard to trophoblast invasion waves. As per results, association analysis of Factor II activity value and gestational complications was carried out. Results: In the control group, the median (Me) of Factor II activity ranged from 108% (preconception period) to 144% (pregnancy) [95% CI 130–150]. In patients with the GA type, the value was significantly higher in related periods, ranging from 149 to 181% [95% CI 142–195], p < 0.0001. With Factor II activity ranging from 148.5 to 180.6%, pregnancies in the main group had no complications. Higher levels of Factor II activity were associated with the development of early and/or severe preeclampsia (PE) and fetal growth retardation (FGR). Conclusion: The data obtained regarding Factor II activity in blood plasma, juxtaposed with the development of great obstetrical syndromes, allow to assume that manifestation of G20210A in early and/or severe PE and FGR is associated with this coagulation factor’s level of activity. Threshold value of the Factor II activity with G20210A mutation, allowing to predict the development of PE, comprised 171.0% at the preconception stage (AUC – 0.86; p < 0.0001) and within 7–8 weeks of gestation it was 181.3% (AUC – 0.84; p < 0.0001).

An issue of venous thromboembolic events (VTEs) in pregnant women and puerperas in Russia as well as throughout the world remains relevant. Specialized events with expert’s participation could not be better to promote active discussion and constructive solution of complex problems, which refer to issues of VTEs prevention. Indeed, not disputable issues can be solved, but critical look and reasoned opinion leader presentations in the field undoubtedly improve our understanding and approaches to prevention of threatening complications in pregnant women and puerperas such as VTEs. In addition, actively discussed new data for dosing of low molecular weight heparins (LMWH) in pregnant women will allow to update current clinical guidelines, which would probably improve clinical outcomes of therapy.

Background In young women with venous thromboembolism (VTE) related to weak transient risk factors, it remains unknown whether stress levels and intimate partner violence (IPV) are associated with recurrence. The VTE-WEAK study aims to investigate the association between perceived stress and IPV with a recurrence of VTE in women with a first episode of VTE due to combined oral contraceptives, pregnancy-puerperium, minor trauma/fracture, brief surgery, infection or brief immobility, and not using antithrombotic prophylaxis. Material and Methods We performed a multicenter, international, observational, retrospective study on women referred for thrombophilia screening who were subsequently monitored. Patients were aged 18 to 55 years old and free of high-risk thrombophilia. When a recurrence of VTE was suspected for the first time, the perceived stress level and IPV were evaluated using self-administrated PSS-10 and Woman Abuse Screening Tool (WAST) questionnaires. Results We monitored 7,754 women over 43,880 patients–years. A first suspected recurrence occurred in 4,772 women, among whom 1,316 had an objectively confirmed recurrence. The perceived stress level and an IPV situation were both independent risk factors for recurrence: moderate stress: adjusted odds ratio (aOR) 1.630 (1.415–2.468); high perceived stress: aOR 10.03 (7.528–13.36); IPV: 1.953 (1.546–2.468), p < 0.0001. Conclusion The perceived level of stress and IPV are associated with a recurrence of VTE when suspected. The mechanisms and clinical consequences of a possible stress coagulopathy require investigation.