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Defining venous thromboembolism and measuring its incidence using Swedish health registries: a nationwide pregnancy cohort study

Abdul Sultan, Alyshah; West, Joe; Stephansson, Olof; Grainge, Matthew J.; Tata, Laila J.; Fleming, Kate M.; Humes, David; Ludvigsson, Jonas F.


Alyshah Abdul Sultan

Professor of Epidemiology

Olof Stephansson

Kate M. Fleming

Clinical Associate Professor

Jonas F. Ludvigsson


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.


Abdul Sultan, A., West, J., Stephansson, O., Grainge, M. J., Tata, L. J., Fleming, K. M., …Ludvigsson, J. F. (2015). Defining venous thromboembolism and measuring its incidence using Swedish health registries: a nationwide pregnancy cohort study. BMJ Open, 5(11), Article e008864.

Journal Article Type Article
Publication Date Nov 11, 2015
Deposit Date Mar 4, 2016
Publicly Available Date Mar 4, 2016
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 5
Issue 11
Article Number e008864
Public URL
Publisher URL


Sultan 2015 BMJ Open.pdf (1000 Kb)

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