Postpartum Pharmacologic Thromboprophylaxis Implementation Varies Widely

A multicenter study found that only 11.9% of postpartum patients received pharmacologic thromboprophylaxis, with wide institutional variation and higher use following cesarean delivery.

Analyzing data from 21,114 individuals who gave birth at 17 hospitals across the United States between 2019 and 2020, researchers examined the rate of postpartum pharmacologic thromboprophylaxis and its associated risks. The study excluded patients with an antepartum venous thromboembolism (VTE) diagnosis, those already receiving anticoagulation therapy, and individuals with known SARS-CoV-2 infection.

The findings revealed that 11.9% of postpartum individuals received pharmacologic thromboprophylaxis, with significant differences based on the mode of delivery. While 29.8% of those undergoing cesarean delivery received prophylaxis, only 3.5% of vaginal deliveries were followed by pharmacologic intervention. Institutional variation was substantial, with rates ranging from 0.21% to 34.8%. Most patients (83.3%) received thromboprophylaxis only while hospitalized, rather than continuing treatment in the outpatient setting.

Key factors associated with thromboprophylaxis administration included cesarean delivery, hysterectomy, and obesity. In adjusted analyses, cesarean delivery was the strongest predictor of thromboprophylaxis (adjusted odds ratio [OR] = 19.17), followed by hysterectomy (adjusted OR = 15.70) and obesity (adjusted OR = 3.45). Despite concerns about potential risks, the study found no significant association between thromboprophylaxis administration and increased rates of surgical site infection, bleeding complications, or postpartum readmission.

The overall incidence of postpartum VTE was low at 0.06%, with a higher rate observed among those who received prophylaxis (0.2%) compared with those who did not (0.04%). The authors noted that this finding may reflect the higher baseline risk in patients selected for prophylaxis rather than an increased risk caused by anticoagulation.

Limitations included the observational design and reliance on hospital records, which may not fully capture outpatient complications.

Reference
Bruno AM, Sandoval GJ, Hughes BL, et al. Postpartum pharmacologic thromboprophylaxis and complications in a US cohort. Am J Obstet Gynecol. 2024;231(1):128.e1-128.e11. doi:10.1016/j.ajog.2023.11.013