Current obstetric guidelines on thromboprophylaxis in the United Kingdom: evidence based medicine?

Wu, Pensée; Poole, T.; Pickett, J.A.; Bhat, A.; Lees, C.

doi:10.1016/j.ejogrb.2012.12.022

Cited by 26 publications

(25 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies rated as '2þ' are "well-conducted case-control or cohort studies with a low risk of confounding, bias or chance and a moderate probability that the relationship is causal". This lack of Grade A evidence has caused concern that the widespread use of LMWH may have unintended consequences, and has led to an urgent call for large-scale and well-designed studies [50]. Guideline compilers themselves are well aware of the preponderance of Grade C recommendations and have called for appropriate clinical studies to be carried out to address the inadequacy of present evidence [41].…”

Section: Implementation Of Guidelinesmentioning

confidence: 99%

Deep venous thrombosis and pulmonary embolism in obese women

Drife¹

2015

Best Practice & Research Clinical Obstetrics & Gynaecol

View full text Add to dashboard Cite

Section: Implementation Of Guidelinesmentioning

confidence: 99%

Deep venous thrombosis and pulmonary embolism in obese women

Drife¹

2015

Best Practice & Research Clinical Obstetrics & Gynaecol

View full text Add to dashboard Cite

“…There is concern that widespread use of thromboprophylaxis during pregnancy will be associated with increased costs, additional demand on resources and unnecessary complications (Wu et al, 2013).…”

Section: Conclusion and Future Researchmentioning

confidence: 99%

“…RCOG guidelines recommend initiation of risk assessment for VTE in early pregnancy or prenatally (NelsonPiercy et al, 2009) and guidelines from other countries have incorporated many elements of these guidelines (Wu et al, 2013). International guidelines agree that women at risk should be considered for thromboprophylaxis but there are variations among organizations with regard to which risk factors are included and how these should be used in the assessments (Okoroh et al, 2012).…”

Section: Current Management Approachesmentioning

confidence: 99%

The prevention of pregnancy‐related venous thromboembolism

2014

View full text Add to dashboard Cite

SummaryPregnancy-related venous thromboembolism (VTE) remains one of the leading causes of maternal mortality and morbidity in the developed world. There is a lack of high-level data surrounding the use of thromboprophylaxis in pregnancy. In the UK, following the publication of the first Royal College of Obstetricians and Gynaecologists (RCOG) guideline for VTE prophylaxis during pregnancy and the puerperium in 2004, a fall in maternal deaths secondary to VTE was observed during the subsequent triennium (2006)(2007)(2008). For the first time since 1985, VTE was no longer the most common cause of maternal death. Low-molecular-weight-heparin (LMWH) is generally the agent of choice for thromboprophylaxis in this setting, and is considered safe and efficacious. The accurate risk stratification of women in order to allow the targeted provision of thromboprophylaxis is challenging. A number of international guidelines support risk assessment for pregnancyrelated VTE and the provision of LMWH for those who are deemed at sufficiently high risk. This review describes the importance of VTE in pregnancy and the puerperium, the part played by different risk factors and the role of thromboprophylaxis in this group of patients.

show abstract

“…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.…”

Section: Lessons Of Evidence‐based Medicinementioning

confidence: 99%

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

Kotaska

2018

BJOG

View full text Add to dashboard Cite

Based on prediction models and expert opinion, most obstetric venous thromboembolism guidelines recommend low‐molecular‐weight heparin for many postpartum women, including most delivering by caesarean. Scrutiny reveals major oversights: prediction models are based on studies that report asymptomatic deep vein thrombosis; risk estimates are not adjusted for time exposure; and harm caused by heparin has been overlooked. The benefits of heparin are exaggerated and its harms are under‐appreciated. Estimates of the numbers‐needed‐to‐treat and harm are universally lacking. This paper critically reviews the evidence and quantifies the benefit and harm from low‐molecular‐weight heparin in postpartum women with common risk factors.FundingThis work was unsponsored and unfunded.Tweetable abstractRandomised trials should demonstrate more benefit than harm before widespread postpartum low‐molecular‐weight heparin is recommended.

show abstract

Current obstetric guidelines on thromboprophylaxis in the United Kingdom: evidence based medicine?

Cited by 26 publications

References 22 publications

Deep venous thrombosis and pulmonary embolism in obese women

Deep venous thrombosis and pulmonary embolism in obese women

The prevention of pregnancy‐related venous thromboembolism

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

Contact Info

Product

Resources

About