Blood Clot Prevention Underused After Cesarean Section in US

November 12, 2013

By Megan Brooks

NEW YORK (Reuters Health) Nov 12 - Thromboembolism prophylaxis after cesarean section remains underused in the United States, according to a new study.

The study did show increased adoption of recommended blood clot prevention strategies after C-section since 2003. But, as of 2010, fewer than half of women in the U.S. who delivered by C-section received venous thromboembolism prophylaxis.

"The key message for doctors is that we have a cheap, safe, and effective means of preventing dangerous blood clots after cesarean delivery that is not being used as often as it should be," Dr. Alexander Friedman from the Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University in New York, told Reuters Health.

"Given how many women undergo cesarean delivery using the right prophylaxis would represent a major improvement in maternal care," he added.

The American College of Obstetricians and Gynecologists recommends universal post-cesarean mechanical thromboembolism prophylaxis and says post-cesarean heparin prophylaxis may offer benefits for patients with additional risk factors. The American College of Chest Physicians and national guidelines from the UK, Sweden and Canada also advise considering post-cesarean heparin prophylaxis for high-risk patients.

Dr. Friedman and colleagues designed their study to characterize contemporary practice patterns for post-cesarean thromboembolism prophylaxis and "determine whether opportunities to substantially decrease maternal mortality and morbidity in this clinical setting are being missed," they explain in a report online November 6 in Obstetrics & Gynecology.

They identified more than 1.2 million women who delivered by cesarean section between 2003 and 2010 in the Premier database, which captures hospitalization data from more than 600 acute care hospitals in the U.S.

They found that 75.7% of the women didn't receive any thromboembolism prophylaxis, 22.1% received mechanical prophylaxis alone, 1.3% received pharmacologic prophylaxis, and 1.0% received combination prophylaxis.

The rate of prophylaxis did increase between 2003 and 2010 from 8.4% to 41.6%, but prophylaxis rates varied significantly by geographic region. Having risk factors for thromboembolism was associated with only modest increases in use of prophylaxis.

"Although our findings demonstrate increasing use of postcesarean mechanical prophylaxis, at the end of the study period, there was still significant underuse of this recommended means of reducing maternal morbidity and mortality," the authors note in their paper.

"Our findings support the need for clear guidelines and protocols for thromboembolism prophylaxis," they add.

Dr. Friedman told Reuters Health, "The key to turning the tide and increasing prevention is for hospital leadership to get on board. A hospital can go from very low use to very high use by creating simple policies that make it easy for doctors and nurses to give patients the best possible care."


Obstet Gynecol 2013.


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