Pilot PARTUM Trial: Postpartum Aspirin to Reduce Thromboembolism Undue Morbidity (PARTUM)

This is an interventional prevention trial for Venous Thromboembolism focused on measuring deep vein thrombosis, pulmonary embolism, postpartum, pregnancy, thrombophilia, cesarean delivery, pre-eclampsia, postpartum hemorrhage Read More

Inclusion Criteria: Study inclusion criteria includes one (or more) first order criterion or two (or more) second order criteria. A patient is still eligible if they have multiple criteria met, at the discretion of the local investigator.

ONE (or more) First Order Criteria:

1. Known inherited thrombophilia diagnosed prior to enrolment:

   i) Heterozygous factor V Leiden, OR ii) Heterozygous prothrombin gene variant, OR iii) Protein C deficiency, OR iv) Protein S deficiency

2. Immobilization (90% of waking hours spent in bed) for ≥7 days anytime during the antepartum period

TWO (or more) Second Order Criteria:

1. Postpartum infection
2. Postpartum hemorrhage (>1000 mL of blood loss, regardless of delivery mode)
3. Pre-pregnancy BMI ≥30 kg/m2
4. Emergency or unplanned cesarean delivery
5. Smoking ≥5 cigarettes/day before pregnancy
6. Pre-eclampsia
7. Current pregnancy ending in stillbirth (pregnancy loss >20 weeks gestation)
8. Small-for-gestational-age infant (<3rd percentile adjusted for gestational age and sex).
9. Previous history of superficial vein thrombosis

Exclusion Criteria:

1. More than 48 hours since delivery
2. Received more than 2 doses of low-molecular-weight heparin (LMWH) since delivery

3. Need for postpartum LMWH prophylaxis or systemic anticoagulation as judged by the local investigator. May include but is not limited to:

   1. Documented history of provoked or unprovoked VTE
   2. Mechanical heart valve(s)
   3. Known antiphospholipid syndrome
   4. Known high-risk inherited thrombophilia i) Antithrombin deficiency; ii) Homozygous factor V Leiden; iii) Homozygous prothrombin gene mutation; iv) Compound heterozygosity factor V Leiden and prothrombin gene mutation; v) More than one inherited thrombophilia

4. Need for postpartum aspirin as judged by the local investigator. May include but is not limited to:

   1. Documented history of myocardial infarction
   2. Documented history of ischemic stroke or transient ischemic attack (TIA)

5. Contraindication to aspirin including:

   1. History of known aspirin allergy
   2. Documented history of a gastrointestinal ulcer
   3. Known platelet count <50 x 109/L at any time during the current pregnancy or postpartum
   4. Active bleeding at any site, excluding normal vaginal bleeding, at the time of randomization
   5. Most recent known hemoglobin ≤70 g/L documented during the current pregnancy or postpartum
   6. Known severe hypertension (SBP >200mm/hg and/or DBP >120mm/hg) during the current pregnancy or postpartum
6. <18 years of age
7. Unable or refused consent