Venous Thromboembolism: Comparing Risk Assessment Tools for Postpartum Prophylaxis in a Teaching Hospital [12K

Abstract

INTRODUCTION: During the first 6 weeks postpartum, patients are 2.5 to 84 times more likely to have a venous thromboembolism (VTE). While risk is increased, the overall incidence of VTE is low, making the establishment of consistent VTE prophylaxis recommendations difficult. We identified population-specific risk factors and compared assessment tools and recommendations from the American College of Obstetricians and Gynecologists, American Academy of Chest Physicians, and Royal College of Obstetricians and Gynecologists. We also investigated adherence to our current VTE risk assessment tool and prophylaxis guidelines. METHODS: 253 postpartum patients from our hospital were randomly selected and their charts reviewed to identify demographics, medical risk factors, hospital management, and postpartum complications. RESULTS: The most common risk factors in our population were a body mass index greater than or equal to 30 (59%) and Cesarean delivery (35%). Using the RCOG and ACCP guidelines, pharmacologic prophylaxis was recommended in 59% and 17% of patients, respectively. Appropriate utilization of our current VTE risk assessment tool yielded a recommendation for pharmacologic prophylaxis in 30% of patients. Our tool was only completed in 21-25% of patients and 6% of patients actually received pharmacologic prophylaxis. CONCLUSION: Significant variation in recommendations exist when applying published guidelines to our population. Our current assessment tool is underutilized and use of pharmacologic prophylaxis is lower than all available recommendations. Standardizing postpartum pharmacological prophylaxis guidelines may help decrease variations in practice and promote pharmacologic prophylaxis in patients at high risk of VTE, a leading cause of maternal morbidity and mortality.