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Master Thesis

Prophylaxie de la maladie veineuse thromboembolique en post-partum : étude de pratique au CHU de Brest en 2013-2014

Abstract : Venous thromboembolism (VTE) is one of the leading causes of maternal mortality in Western countries, ie 6-10 VTE maternal deaths per year in France. Population studies have identified key risk factors (RF) for VTE during postpartum (PP). Thromboprophylaxis recommendations in PP exist in France (SFAR 2005) and abroad, but with low scientific level of evidence and several differences in care exist. We studied the adequacy of the practices compared to recommendations of the SFAR in 1835 women who gave birth in BREST between 2013 and 2014. We used data from the HPP-IPF study, prospective cohort, with complementary hospital records. We excluded 4 women on curative anticoagulants. We studied thromboprophylaxis for patients at moderate, high and major risk (as classified by the SFAR), patients who underwent cesarean section and a sample of 90 patients at low risk without cesarean section, ie 515 cases, of which 490 were analyzed. - 34% of women at risk for VTE PP have received appropriate thromboprophylaxis. - 97.8% of caesarean sections without further RF were overtreated (short treatment (TX)). - 4.2% of patients at moderate risk requiring six weeks TX received adequate TX. - non caesarean low-risk patients have not received TX. These results show a relatively low adherence to recommendations. Caesarean section, VTE history and thrombophilia seem taken into account but the moderate-risk patients (without cesarean section or previous history of VTE) combining low FDR are undertreated. Ignorance of the recommendations of the SFAR, complexity, scientific weakness are obstacles to the adherence of the practitioner. Clinical studies are needed to confirm the best preventive strategy as well as simplification of recommendations and enhancement of RF in the patient file (VTE questionnaire).
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01112780
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Tuesday, February 3, 2015 - 4:07:38 PM
Last modification on : Wednesday, August 23, 2017 - 4:31:58 PM
Long-term archiving on: : Wednesday, May 27, 2015 - 4:22:40 PM

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Pascal Nicolas. Prophylaxie de la maladie veineuse thromboembolique en post-partum : étude de pratique au CHU de Brest en 2013-2014. Médecine humaine et pathologie. 2015. ⟨dumas-01112780⟩

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