A comparison of recommendations for pharmacologic thromboembolism prophylaxis after caesarean delivery from three major guidelines

Abstract

Recommendations from major society guidelines for post-caesarean thromboprophylaxis differ greatly.

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

“…A recent review of post-cesarean delivery patients found that 1%, 35%, and 85% of patients would receive pharmacologic prophylaxis under the ACOG, ACCP, and Royal College of Obstetricians and Gynaecologists criteria, respectfully. 11,263 In an effort to reduce the frequency of obstetric thromboembolism and improve maternal outcomes, the NPMS, a multidisciplinary working group representing all major women's health care professional organizations, has recently published a Consensus Bundle on Venous Thromboembolism. 13 The bundle advocates for more aggressive risk-based assessment of obstetric patients, which will ultimately result in not only an increased use, but also likely increased doses of antithrombotic agents.…”

Profilaxis tromboembólica en pacientes posparto. Estudio de corte transversal en tres instituciones en Colombia

“…Esta disparidad se puede explicar porque la evidencia para apoyar o sugerir diferentes factores de riesgo como indicativos de tromboprofilaxis no es alta (17). Un trabajo publicado por Palmerola et al, en el que se comparan tres guías con 293 pacientes sometidas a cesárea encontraron que el 85 % de las pacientes, según el RCOG, deberían recibir tromboprofilaxis, el 1 % según recomendaciones de ACOG y el 38,4 % según las guías del CHEST (18). No obstante, existe una constante en todas las guías que es importante resaltar y es la necesidad de evaluar el riesgo trombótico en todas las pacientes durante el embarazo y en el posparto inmediato (16).…”

Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence‐based lens

“…Investigators have called for RCTs to evaluate postpartum LMWH prophylaxis 1, 2, 44, 68. Although RCTs have drawbacks when applied to complex phenomena, they are ideally suited to evaluate drug therapy 29, 69.…”

“…Since the magnitudes of potential benefit and harm are very small, the numbers required to achieve adequate power are daunting; however, large trials of medical and surgical patients have been conducted successfully. Using inclusion criteria from the current RCOG guideline, more than 80% of women undergoing CD would qualify 2. With CD rates exceeding 30% in some jurisdictions, this equates to more than a thousand women annually in many large maternity hospitals.…”