Title: Impact of Implementation of Chemoprophylaxis for Prevention of Venous Thromboembolism After Cesarean Delivery
Presenter: Alexis G Bridges, DO
Contributors: Torri Metz, MD (University of Utah); Amanda Allshouse, MS (University of Utah); Ann Bruno, MD (University of Utah)
Faculty Sponsor: Brett Einerson, MD (University of Utah)
Brief Description: VTE prevention protocol increases rate of chemoprophylaxis use in high-risk women undergoing cesarean delivery without increasing wound complications
Keywords/Main Subjects: Chemoprophylaxis, cesarean delivery, venous thromboembolism
Copyright: copyright Alexis G Bridges et. al. ©2020
Many institutions have implemented protocols for prevention of postpartum venous thromboembolism (VTE) in an effort to reduce maternal deaths. Our objective was to evaluate the impact of implementing a VTE chemoprophylaxis protocol for women after cesarean delivery (CD) on rate of chemoprophylaxis, VTE and wound complications.
Retrospective cohort study of women who delivered via CD from 2016-19 at a single, tertiary center before and after implementation of a VTE prevention protocol. Women classified as “high risk” for VTE qualified for chemical prophylaxis. The primary outcome was rate of chemoprophylaxis use. Secondary outcomes included VTE and wound complications. Demographics, chemoprophylaxis use, and outcomes were compared year-to-year post implementation using a chi-square test for trend. Trajectory (slope) of primary outcome was estimated in logistic regression and compared pre and post-protocol.
4239 CDs were included. Yearly post-protocol rates of chemoprophylaxis increased significantly with each year of implementation (11.9% in 2017, 19.7% in 2018, 24.2% in 2019, trend p <.001, Figure). There was no change in wound complications (2.0% in 2016, 1.3% in 2017, 2.0% in 2018, and 2.5% in 2019)(p=0.30). There were no cases of VTE pre-protocol and two cases of VTE post-protocol. The two women with VTEs post-protocol qualified for prophylaxis but did not receive it.
A VTE prevention protocol for women undergoing CD significantly increased chemoprophylaxis use in “high risk” patients without increasing wound complications. VTE events occurred in women who qualified for, but did not receive, prophylaxis indicating incomplete acceptance of adopted guidelines despite an electronic order set.