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Type: Artigo
Title: Women's Values And Preferences And Health State Valuations For Thromboprophylaxis During Pregnancy: A Cross-sectional Interview Study
Author: Bates
Shannon M.; Alonso-Coello
Pablo; Tikkinen
Kari A. O.; Ebrahim
Shanil; Lopes
Luciane Cruz; McDonald
Sarah D.; Zhou
Qi; Akl
Elie A.; Neumann
Ignacio; Jacobsen
Anne Flem; Zhang
Yuqing; Santamara
Amparo; Annichino-Bizzacchi
Joyce Maria; Sandset
Per Morten; Bitar
Wael; Eckman
Mark H.; Guyatt
Gordon H.
Abstract: Pregnant women with prior venous thromboembolism (VTE) are at risk of recurrence. Prophylaxis with low molecular weight heparin (LWMH) reduces that risk but is inconvenient, costly, and may be associated with increased risks of obstetrical bleeding. The views of pregnant women, crucial when making prophylaxis recommendations, are currently unknown. Methods: Cross-sectional international multicenter study. We included women with a history of VTE who were either pregnant or planning pregnancy. We provided information regarding risk of VTE recurrence with and without LMWH and determined participant's willingness to receive LMWH prophylaxis through direct choice exercises, preference-elicitation (utilities) for health states (e.g. burden of LMWH prophylaxis), and a probability trade-off exercise. Results: Of 123 women, more women at high risk than those at low risk of recurrence (86.4% vs. 60.0%; p=0.003) chose to use LMWH. The median threshold reduction in VTE at which women were willing to accept use of LMWH, given a 16% risk of VTE without prophylaxis, was 3% (interquartile range: 1 to 6). Participants' evaluation of the relevant health states varied widely and was unrelated to their direct choices to use or not use LMWH. Conclusions: Although the majority of women with a previous VTE, pregnant or planning pregnancy choose to take LMWH during pregnancy, a minority -and in low risk women, a large minority-do not. Our results highlight the need for individualized shared decision-making (SDM) in the clinical encounter, and for guideline panels to make weak recommendations in favor of LMWH that make clear the need for SDM. (C) 2015 Elsevier Ltd. All rights reserved.
Subject: Women's Health
Obstetrics And Gynecology
Evidence-based Medicine
Clinical Practice Guidelines
Decision Making
Editor: Pergamon-Elsevier Science LTD
Rights: fechado
Identifier DOI: 10.1016/j.thromres.2015.12.015
Date Issue: 2016
Appears in Collections:Unicamp - Artigos e Outros Documentos

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