Antepartum and Postpartum Thromboprophylaxis Preferences: Insights From a Single-Center Survey

Venous thromboembolism (VTE) is a significant contributor to maternal morbidity and mortality worldwide. Thromboprophylaxis guidelines are critical for VTE prevention, yet the optimal implementation of risk-appropriate thromboprophylaxis during pregnancy and postpartum remains uncertain.

To describe VTE risk assessment and thromboprophylaxis practices by medical practitioners in Obstetrics in a middle income setting as well as the barriers among obstetricians that may influence adherence to VTE guidelines.

An electronic survey was distributed to 120 medical practitioners at the University of the Witwatersrand, Johannesburg, South Africa to assess thromboprophylaxis practices in pregnancy and postpartum.

Seventy (58%) responses were received, and 64 (53%) complete responses were analyzed. Most respondents practiced in the public sector (n = 53, 83%) and followed clinical guidelines, with 32 (50%) adhering to the Royal College of Obstetricians and Gynaecologists (RCOG) guideline. Low molecular weight heparin was widely prescribed during both antepartum and postpartum periods (n = 59, 92%), primarily at a fixed low-dose (n = 30/64, 47%). Barriers to the use of thromboprophylaxis included lack of mechanical prophylaxis (n = 19, 30%), perceived complications of thromboprophylaxis (n = 18, 28%), and cost (n = 14, 22%). Case-based assessments revealed significant variation in practices due to complex risk assessment scoring systems and disparate guideline recommendations.

This survey provides insights into the practical issues affecting guideline and risk assessment tool implementation as well as challenges in a real-world clinical setting.