{"doi":"10.1002/pmf2.70082","title":"Postpartum thromboembolism risk by CHA <sub>2</sub> DS <sub>2</sub> ‐VASc score in patients with atrial fibrillation or flutter during pregnancy","abstract":"Abstract Introduction 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 2 DS 2 ‐VASc scores 1 versus ≥ 2 (i.e., those with risk factors beyond female sex). Methods This retrospective cohort study used the 2016–2021 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‐transfusion and cardiovascular‐related SMM, mode of delivery, preterm birth, and patient disposition. CHA 2 DS 2 ‐VASc scores were calculated for each patient at the index hospitalization and scores compared as 1 and ≥ 2. After adjusting for facility characteristics and obesity, a modified Poisson regression model was used to estimate relationships between groups. Results 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 2 DS 2 ‐VASc score of 1 and 1638 (24.0%) had a CHA 2 DS 2 ‐VASc ≥ 2. After adjusting for facility and patient characteristics, patients with a CHA 2 DS 2 ‐VASc ≥ 2 were more likely to experience an acute thromboembolic event (3.9% vs. 1.5%, aRR 2.04 [1.16, 3.60]), SMM (23.5% vs. 11.4%, aRR 1.77 [1.47, 2.14]), and pulmonary edema or acute heart failure (11.4% vs. 1.3%, aRR 7.12 [4.46, 11.01]) compared with those with CHA 2 DS 2 ‐VASc of 1 over the 6‐week postpartum period. Patients with AF/AFL and CHA 2 DS 2 ‐VASc of 1 had a TIA/CVA rate of 1.4%, while those with CHA 2 DS 2 ‐VASc ≥ 2 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 2 DS 2 ‐VASc score and need for cardioversion or onset of hemodynamic shock. Conclusions Pregnant patients with a history of AF/AFL and a CHA 2 DS 2 ‐VASc score ≥ 2 are significantly more likely to experience an acute thromboembolic event following delivery than those with a CHA 2 DS 2 ‐VASc 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‐week postpartum period, suggesting that pregnancy and postpartum states have increased risk not accounted for by the CHA 2 DS 2 ‐VASc score. Prospective studies are needed to better understand risk for pregnant and postpartum patients with AF/AFL and to determine optimal management strategies.","journal":"Pregnancy","year":2025,"id":571231,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9591,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1077714,"name":"Sarah Snow","orcid":"0000-0002-7132-9941","position":1,"is_corresponding":false},{"id":1477382,"name":"Miriam Estin","orcid":null,"position":2,"is_corresponding":false},{"id":606680,"name":"Cary Ward","orcid":"0000-0002-5283-0490","position":3,"is_corresponding":false},{"id":734136,"name":"Marie‐Louise Meng","orcid":"0000-0001-8089-3993","position":4,"is_corresponding":false},{"id":337346,"name":"Tracy Truong","orcid":"0000-0001-5923-4037","position":5,"is_corresponding":false},{"id":274057,"name":"Anna Xu","orcid":"0000-0003-4007-5157","position":6,"is_corresponding":false},{"id":548403,"name":"Jerome J. Federspiel","orcid":"0000-0003-0321-6280","position":7,"is_corresponding":false},{"id":443489,"name":"Virginia Y. Watkins","orcid":"0000-0002-7398-9425","position":0,"is_corresponding":true}],"reference_count":38,"raw_metadata":null,"created_at":"2026-07-19T02:57:15.755535Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}