Progress in prevention and prediction of venous thromboembolism in women: Focus on pregnancy and the postpartum period

Although women and pregnant women are increasingly included in studies and research, many knowledge gaps and clinically relevant issues remain unsolved for the pregnant population. The first part of the thesis (chapter 2-7) focuses on the incidence of (recurrent) venous thromboembolism (VTE) and superficial vein thrombosis (SVT) in pregnancy and the postpartum period. Chapter 3 presents the results of the largest, international, randomized controlled trial to date, the Highlow study, comparing an intermediate weight-adjusted dose of low-molecular-weight heparin (LMWH) to a fixed low dose of LMWH to prevent recurrent VTE in pregnant and postpartum women. Chapter 4 presents the results of a sub-analysis of the Highlow study about the number of women receiving neuraxial anesthesia and whether this differs between the two LMWH doses. Chapter 5 reports on the incidence of SVT and the risk of subsequent VTE in the pregnant population, which may help physicians to guide treatment decisions. Furthermore, we focus on the prognosis of VTE and pregnancy outcomes in special populations such as women with small for gestational age infants (chapter 6) and those with Budd-Chiari syndrome and/or portal vein thrombosis (chapter 7). The second part of the thesis (chapters 8-11), evaluates VTE in relation to women-specific health such as management and treatment strategies for heavy menstrual bleeding while using anticoagulation (chapter 8) and the risk of recurrence in women with a first VTE related to the use of estrogen-containing contraceptives (chapter 9 and 10).