Postpartum venous thromboembolism chemical prophylaxis and bleeding complications in a U.S. cohort

Abstract

To describe the rate of, and factors associated with, initiation of postpartum venous thromboembolism (VTE) chemical prophylaxis and to assess associated bleeding complications. Secondary analysis of a multicenter cohort of individuals delivering on randomly selected days at 17 U.S. hospitals (2019-20). Medical records were reviewed by trained and certified personnel. Those with an antepartum diagnosis of VTE or receiving antepartum anticoagulation were excluded. The primary outcome was use of postpartum chemical thromboprophylaxis. Secondary outcomes included bleeding complications, surgical site infection, hospital readmission, and VTE through 6 weeks postpartum. The rate of thromboprophylaxis administration was assessed by mode of delivery and whether it was continued after hospital discharge. Multivariable regression models were developed using k-fold cross-validation with stepwise backward elimination to evaluate factors associated with thromboprophylaxis administration. Univariable analyses were performed to assess the association between thromboprophylaxis administration and secondary outcomes. Overall, 12.2% (95% CI 11.7-12.6%) of 21,468 individuals received postpartum chemical thromboprophylaxis: 30% (95% CI 28.9-31.1%) following cesarean and 3.9% (95% CI 3.6-4.2%) following vaginal delivery. The majority (81.5%) received thromboprophylaxis only as inpatients. In adjusted analysis, hysterectomy, cesarean delivery, and obesity were the strongest factors associated with thromboprophylaxis administration (Table 1). The overall rate of VTE was 0.06% (95% CI 0.03-0.09%) and was not lower in those receiving prophylaxis. While absolute rates are low, thromboprophylaxis administration was associated with increased risk of all secondary outcomes (Table 2). Cesarean delivery, hysterectomy, and obesity were predominant factors associated with postpartum thromboprophylaxis administration. Use of thromboprophylaxis was associated with an increase in postpartum bleeding complications.View Large Image Figure ViewerDownload Hi-res image Download (PPT)