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Abdul Sultan, Alyshah and West, Joe and Stephansson, Olof and Grainge, Matthew J. and Tata, Laila J. and Fleming, Kate M. and Humes, David and Ludvigsson, Jonas F. (2015) Defining venous thromboembolism and measuring its incidence using Swedish health registries: a nationwide pregnancy cohort study. BMJ Open, 5 (11). e008864. ISSN 2044-6055

Abstract

Objective: To accurately define venous thromboembolism (VTE) in the routinely collected Swedish health registers and quantify its incidence in and around pregnancy.

Study design: Cohort study using data from the Swedish Medical Birth Registry (MBR) linked to the National Patient Registry (NPR) and the Swedish Prescribed Drug Register (PDR).

Setting: Secondary care centres, Sweden.

Participant: 509 198 women aged 15–44 years who had one or more pregnancies resulting in a live birth or stillbirth between 2005 and 2011.

Main outcome measure: To estimate the incidence rate (IR) of VTE in and around pregnancy using various VTE definitions allowing direct comparison with other countries.

Results: The rate of VTE varied based on the VTE definition. We found that 43% of cases first recorded as outpatient were not accompanied by anticoagulant prescriptions, whereas this proportion was much lower than those cases first recorded in the inpatient register (9%). Using our most inclusive VTE definition, we observed higher rates of VTE compared with previously published data using similar methodology. These reduced by 31% (IR=142/100 000 person-years; 95% CI 132 to 153) and 22% (IR=331/100 000 person-years; 95% CI 304 to 361) during the antepartum and postpartum periods, respectively, using a restrictive VTE definition that required anticoagulant prescriptions associated with diagnosis, which were more in line with the existing literature.

Conclusions: We found that including VTE codes without treatment confirmation risks the inclusion of false-positive cases. When defining VTE using the NPR, anticoagulant prescription information should therefore be considered particularly for cases recorded in an outpatient setting.

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