{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T12:40:56Z","timestamp":1765111256308,"version":"3.46.0"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005831","name":"Foundation for Anesthesia Education and Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005831","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      To evaluate whether rates of postpartum thromboembolism (TE), transient ischemic attack (TIA), and cerebrovascular accident (CVA) among patients with a history of AF\/AFL differed based on CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc scores 1 versus\u00a0\u2265\u00a02 (i.e., those with risk factors beyond female sex).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study used the 2016\u20132021 National Readmissions Database to identify patients with a diagnosis of atrial fibrillation (AF)\/atrial flutter (AFL) at delivery. The primary outcome was rate of acute thromboembolic events (TE\/TIA\/CVA) during delivery hospitalization or within 42 days following discharge. Secondary outcomes included cerebrovascular morbidity specifically (TIA\/CVA), severe maternal morbidity (SMM), non\u2010transfusion and cardiovascular\u2010related SMM, mode of delivery, preterm birth, and patient disposition. CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc scores were calculated for each patient at the index hospitalization and scores compared as 1 and\u00a0\u2265\u00a02. After adjusting for facility characteristics and obesity, a modified Poisson regression model was used to estimate relationships between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort consisted of 3574 delivery hospitalizations with AF\/AFL, corresponding to a national estimate of 6816. Of those, 5178 (76.0%) had a CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc score of 1 and 1638 (24.0%) had a CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc\u00a0\u2265\u00a02. After adjusting for facility and patient characteristics, patients with a CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc\u00a0\u2265\u00a02 were more likely to experience an acute thromboembolic event (3.9%\u00a0vs. 1.5%, aRR 2.04 [1.16, 3.60]), SMM (23.5%\u00a0vs. 11.4%, aRR 1.77 [1.47, 2.14]), and pulmonary edema or acute heart failure (11.4%\u00a0vs. 1.3%, aRR 7.12 [4.46, 11.01]) compared with those with CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc of 1 over the 6\u2010week postpartum period. Patients with AF\/AFL and CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc of 1 had a TIA\/CVA rate of 1.4%, while those with CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc\u00a0\u2265\u00a02 had a TIA\/CVA rate of 2.5%, with no statistically significant difference between groups in adjusted models (aRR 1.37 [0.74, 2.52]). No significant association was observed between CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc score and need for cardioversion or onset of hemodynamic shock.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Pregnant patients with a history of AF\/AFL and a CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc score\u00a0\u2265\u00a02 are significantly more likely to experience an acute thromboembolic event following delivery than those with a CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc of 1. Additionally, baseline rates of TIA\/CVA for pregnant individuals with AF\/AFL but no additional risk factors beyond sex were 1.4% during the 6\u2010week postpartum period, suggesting that pregnancy and postpartum states have increased risk not accounted for by the CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc score. Prospective studies are needed to better understand risk for pregnant and postpartum patients with AF\/AFL and to determine optimal management strategies.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmf2.70082","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:59:21Z","timestamp":1753880361000},"source":"Crossref","is-referenced-by-count":0,"title":["Postpartum thromboembolism risk by CHA\n                    <sub>2<\/sub>\n                    DS\n                    <sub>2<\/sub>\n                    \u2010VASc score in patients with atrial fibrillation or flutter during pregnancy"],"prefix":"10.1002","volume":"1","author":[{"given":"Virginia Y.","family":"Watkins","sequence":"first","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah C.","family":"Snow","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam L.","family":"Estin","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cary C.","family":"Ward","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie\u2010Louise","family":"Meng","sequence":"additional","affiliation":[{"name":"Division of Women's Anesthesia Department of Anesthesiology Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracy","family":"Truong","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerome J.","family":"Federspiel","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Duke University School of Medicine  Durham North Carolina USA"},{"name":"Department of Population Health Sciences Duke University School of Medicine  Durham North Carolina USA"},{"name":"Division of Hematology Department of Medicine Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000003243"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2006.098822"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.14503\/thij\u201021\u20107548"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0029\u20107844(97)85765\u20101"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.68.12.540"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2015.04.013"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.4022\/jafib.295"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2023.05.017"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/grf.0000000000000567"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.5603\/kp.2019.0049"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rec.2016.11.033"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2019.01.024"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(18)31037-4"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euab180"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.11.008"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2023.100555"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010007\u20100256\u20106"},{"volume-title":"Severe Maternal Morbidity in the United States","year":"2024","author":"Centers for Disease Control DoRH","key":"e_1_2_9_19_1"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh090"},{"key":"e_1_2_9_21_1","unstructured":"Yoon F. 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