Implementation of Venous Thromboembolism Prophylaxis After Cesarean at a High Volume Military Treatment Facility [17L]

Abstract

INTRODUCTION: Venous thromboembolism (VTE) is a leading cause of maternal morbidity. In 2016 the National Partnership for Maternal Safety (NPMS) published a Consensus Bundle on Venous Thromboembolism recommending postcesarean dual VTE prophylaxis for a modified Caprini score of 5 or more. The purpose of our study is to determine the impact of policy change from American College of Chest Physicians 2012 guidelines to NPMS in our facility. METHODS: Following stepwise implementation of NPMS guidelines, Caprini score calculation became mandatory after cesarean delivery. We reviewed inpatient enoxaparin prescriptions rate of postcesarean patients, comparing the 12 months before implementation with 12 months post-implementation, excluding 5 months of transition period. We also compared the rate of various adverse outcomes including blood transfusion, epidural hematoma, maternal death, wound hematoma or wound separation, re-operation, heparin induced thrombocytopenia, and venous thromboembolism. Student t-test was performed to compare average rate pre and post policy change. A P<.05 was considered significant. RESULTS: The analysis included 888 cesarean deliveries pre-implementation and 1,515 post-implementation with no difference in demographics or indication for cesarean. Prior to change in policy, 3.6% (+/- 1.5% SD) of patients received dual prophylaxis. After implementation, this rose to 32.7% (+/- 6.7% SD) (P=.001). The number of cesarean deliveries with adverse outcomes up to 84 days postpartum remained stable. There was no statistically significant difference in VTE in the pre-implementation and post-implementation groups. CONCLUSION: Successful implementation of a dual VTE prophylaxis policy postcesarean delivery is possible without adversely affecting complication rates.