274 Healthcare resource utilization associated with a risk-based thromboprophylaxis protocol in obstetric patients

Abstract

Venous thromboembolism (VTE) is a preventable cause of maternal morbidity and death. Guidelines advise a risk-based approach to mechanical and pharmacologic VTE prophylaxis (ppx) in obstetric patients, yet routine use of prophylactic, heparin-based anticoagulation is largely unstudied in this population. Our institution adopted a risk-based protocol for heparin-based VTE ppx in obstetric patients in 2016 (Table 1); we evaluated the impact of this protocol on healthcare resource utilization. Retrospective cohort study of all deliveries at a single tertiary-care center from 2013-2018. Deliveries were categorized as pre- (2013-2015; no standardized heparin ppx) and post-protocol (2016-2018; Table 1). Patients receiving anticoagulation for active VTE or high VTE risk were excluded. Healthcare resource utilization outcomes included anticoagulation use, blood transfusion, readmissions, maternity triage visits, imaging tests, and hematologic laboratory studies performed (Table 2). Pre- and post-protocol outcomes were compared with student’s t-, χ2, and Fisher’s exact tests; adjusted odds ratios (95%CI) were calculated with the pre-protocol cohort as reference. Of 24,229 total deliveries, 11,799 (49%) were pre-, and 12,430 (51%) post-protocol. There was a 15-fold increase in anticoagulation use after protocol adoption (15.6% vs 1.2%, p<0.001). This was associated with significantly more red blood cell transfusions (3.8% vs 2.9%, p<0.001) despite more restrictive transfusion practices. Except for an increase in postpartum platelet studies related to institutional platelet monitoring in heparinized women (18.6% vs 15.4%, p<0.001), no significant changes were seen in utilization of any other resources (Table 2). A risk-based protocol for heparin-based ppx is associated with more anticoagulation administration, platelet studies, and blood transfusions. Further studies are needed to evaluate resource allocation versus safety and efficacy of routine risk-based obstetric VTE ppx.View Large Image Figure ViewerDownload Hi-res image Download (PPT)