Differences in clinical practice guidelines for the use of postpartum thromboprophylaxis and associated VTE risk
| Author, year, and location . | Population . | n (% who underwent CD) . | Proportion meeting criteria for LMWH prophylaxis . | Statements of actual LMWH use . | Incidence of VTE in women who met guideline criteria for LMWH prophylaxis . |
|---|---|---|---|---|---|
| Pamerola,19 2016, USA | Post-CD; cross-sectional chart review at 2 time points in 2013-2014 | 293 CD: 100% | ACOG: 1.0% RCOG: 85% ACCP: 34.8% | “At the centre where this study was performed, heparin is administered empirically to all women after CD unless there is a specific contraindication.” | NR |
| Omunakwe,20 2016, UK | All deliveries; 4 weeks in September-October 2015 | 227 CD: 35% | RCOG: 46.6% | NR | NR |
| O'Shaughnessy,21 2019, Ireland | All deliveries; cross-sectional study of prospectively collected data; January 2015 to December 2017 | 21 019 CD: 32% | ACOG: 8% RCOG: 37% ACCP: 7% Australia/New Zealand: 23% SOGC: 15% | NR | NR |
| Federspiel et al,22 2021, USA | Post-CD; Nationwide Readmissions Database, October 2015 to December 2017 | 1 390 603 CD: 100% | ACOG: 0.3% RCOG: 73.4% ACCP: 16.2% ASH: 0.2%* | Unknown | VTE incidence per 1000 deliveries: ACOG: 19.5 (14.9-23.9) RCOG: 1.9 (1.8-2.0) ACCP: 4.2 (3.9-4.6) ASH: 20.0 (14.9-25.7) |
| Gassmann et al,23 2021, Switzerland | All deliveries in January 2019; retrospective chart review | 344 CD: 23.3% | ACOG: 8.7% RCOG: 40.1% (34.9%-45.5%) ACCP: 9.9% ASH: 0%* | 24% “Standard of care is to prescribe thromboprophylaxis to women with CD. For women with vaginal delivery, LMWH is restricted to those with thrombophilia or prior VTE, following individual hemostasis consultation.” | Calculated based on Sultan risk score: ACOG: 0.20% RCOG: 0.12% ACCP: 0.20%; |
| Author, year, and location . | Population . | n (% who underwent CD) . | Proportion meeting criteria for LMWH prophylaxis . | Statements of actual LMWH use . | Incidence of VTE in women who met guideline criteria for LMWH prophylaxis . |
|---|---|---|---|---|---|
| Pamerola,19 2016, USA | Post-CD; cross-sectional chart review at 2 time points in 2013-2014 | 293 CD: 100% | ACOG: 1.0% RCOG: 85% ACCP: 34.8% | “At the centre where this study was performed, heparin is administered empirically to all women after CD unless there is a specific contraindication.” | NR |
| Omunakwe,20 2016, UK | All deliveries; 4 weeks in September-October 2015 | 227 CD: 35% | RCOG: 46.6% | NR | NR |
| O'Shaughnessy,21 2019, Ireland | All deliveries; cross-sectional study of prospectively collected data; January 2015 to December 2017 | 21 019 CD: 32% | ACOG: 8% RCOG: 37% ACCP: 7% Australia/New Zealand: 23% SOGC: 15% | NR | NR |
| Federspiel et al,22 2021, USA | Post-CD; Nationwide Readmissions Database, October 2015 to December 2017 | 1 390 603 CD: 100% | ACOG: 0.3% RCOG: 73.4% ACCP: 16.2% ASH: 0.2%* | Unknown | VTE incidence per 1000 deliveries: ACOG: 19.5 (14.9-23.9) RCOG: 1.9 (1.8-2.0) ACCP: 4.2 (3.9-4.6) ASH: 20.0 (14.9-25.7) |
| Gassmann et al,23 2021, Switzerland | All deliveries in January 2019; retrospective chart review | 344 CD: 23.3% | ACOG: 8.7% RCOG: 40.1% (34.9%-45.5%) ACCP: 9.9% ASH: 0%* | 24% “Standard of care is to prescribe thromboprophylaxis to women with CD. For women with vaginal delivery, LMWH is restricted to those with thrombophilia or prior VTE, following individual hemostasis consultation.” | Calculated based on Sultan risk score: ACOG: 0.20% RCOG: 0.12% ACCP: 0.20%; |
The 2018 ASH guidelines did not specifically comment on post-CD thromboprophylaxis use (see Table 1).
NR, not reported.