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A More Selective vs a Standard Risk-Stratified, Heparin-Based, Obstetric Thromboprophylaxis Protocol.
Macie L Champion1, Christina T Blanchard1, Michelle Y Lu2
1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham.
JAMA
|June 27, 2024
Summary
A revised postpartum enoxaparin protocol reduced wound hematomas without increasing venous thromboembolism (VTE) risk. This selective approach to VTE prophylaxis in obstetric patients is effective.
Area of Science:
- Obstetrics and Gynecology
- Thrombosis and Hemostasis
- Pharmacology
Background:
- Pregnancy-related venous thromboembolism (VTE) prophylaxis is crucial.
- Initial risk-stratified enoxaparin protocols led to increased wound hematomas.
- A revised, more selective protocol was implemented in 2021.
Purpose of the Study:
- To evaluate the outcomes of a more selective, risk-stratified heparin-based (enoxaparin) obstetric thromboprophylaxis protocol.
- To assess the impact of protocol changes on wound hematoma and VTE rates.
Main Methods:
- Retrospective observational study of 17,489 patients.
- Comparison between an original protocol (2016-2018) and a more selective protocol (2021-2023).
- Exclusion of patients on outpatient anticoagulation for active VTE or high VTE risk.
Main Results:
- Chemoprophylaxis rates decreased from 16% to 8% with the more selective protocol.
- The selective protocol was associated with a significant decrease in wound hematomas (0.7% vs 0.3%).
- No significant increase in postpartum venous thromboembolism (VTE) was observed (0.1% vs 0.1%).
Conclusions:
- A more selective, risk-stratified enoxaparin thromboprophylaxis protocol reduces wound hematoma rates.
- The revised protocol achieves this reduction without an increase in postpartum VTE.
- This approach offers a safer and more effective strategy for VTE prophylaxis in obstetric patients.
