دورية أكاديمية
Evaluation of a Risk-Stratified, Heparin-Based, Obstetric Thromboprophylaxis Protocol.
| العنوان: | Evaluation of a Risk-Stratified, Heparin-Based, Obstetric Thromboprophylaxis Protocol. |
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| المؤلفون: | Lu MY; Center for Women's Reproductive Health, the Department of Obstetrics and Gynecology, and the Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Novant Health Maternal-Fetal Medicine, Charlotte, North Carolina; the Department of Otolaryngology, University of Mississippi Medical Center, Jackson, Mississippi; the Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana; the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; and the University of Alabama at Birmingham School of Medicine, Birmingham, Birmingham, Alabama., Blanchard CT, Ausbeck EB, Oglesby KR, Page MR, Lazenby AJ, Cozzi GD, Muñoz Rogers RD, Bushman ET, Kaplan ER, Ruzic MF, Mahalingam M, Dunk S, Champion M, Casey BM, Tita AT, Kim DJ, Szychowski JM, Subramaniam A |
| المصدر: | Obstetrics and gynecology [Obstet Gynecol] 2021 Oct 01; Vol. 138 (4), pp. 530-538. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0401101 Publication Model: Print Cited Medium: Internet ISSN: 1873-233X (Electronic) Linking ISSN: 00297844 NLM ISO Abbreviation: Obstet Gynecol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2004- : Hagerstown, MD : Lippincott Williams & Wilkins Original Publication: New York. |
| مواضيع طبية MeSH: | Delivery, Obstetric*, Anticoagulants/*therapeutic use , Heparin/*therapeutic use , Pregnancy Complications, Cardiovascular/*prevention & control , Venous Thromboembolism/*prevention & control, Adult ; Blood Transfusion/statistics & numerical data ; Female ; Hematoma/epidemiology ; Humans ; Postoperative Complications/epidemiology ; Postpartum Hemorrhage/epidemiology ; Pregnancy ; Program Evaluation ; Retrospective Studies ; Risk Factors ; Young Adult |
| مستخلص: | Objective: To evaluate outcomes before and after implementation of a risk-stratified heparin-based obstetric thromboprophylaxis protocol. Methods: We performed a retrospective cohort study of all patients who delivered at our tertiary care center from 2013 to 2018. Deliveries were categorized as preprotocol (2013-2015; no standardized heparin-based thromboprophylaxis) and postprotocol (2016-2018). Patients receiving outpatient anticoagulation for active venous thromboembolism (VTE) or high VTE risk were excluded. Coprimary effectiveness and safety outcomes were postpartum VTEs and wound hematomas, respectively, newly diagnosed after delivery and up to 6 weeks postpartum. Secondary outcomes were other wound or bleeding complications, including unplanned surgical procedures (eg, hysterectomies, wound explorations) and blood transfusions. Outcomes were compared between groups, and adjusted odds ratios (aORs) and 95% CIs were calculated using the preprotocol group as reference. Results: Of 24,229 deliveries, 11,799 (49%) occurred preprotocol. Although patients were more likely to receive heparin-based prophylaxis postprotocol (15.6% vs 1.2%, P<.001), there was no difference in VTE frequency between groups (0.1% vs 0.1%, odds ratio 1.0, 95% CI 0.5-2.1). However, patients postprotocol experienced significantly more wound hematomas (0.7% vs 0.4%, aOR 2.34, 95% CI 1.54-3.57), unplanned surgical procedures (aOR 1.29, 95% CI 1.06-1.57), and blood transfusions (aOR 1.34, 95% CI 1.16-1.55). Conclusion: Risk-stratified heparin-based thromboprophylaxis in a general obstetric population was associated with increased wound and bleeding complications without a complementary decrease in postpartum VTE. Guidelines recommending this strategy should be reconsidered. Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest. (Copyright © 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.) |
| التعليقات: | Comment in: Obstet Gynecol. 2021 Oct 1;138(4):527-529. (PMID: 34623064) Comment in: Obstet Gynecol. 2022 Feb 1;139(2):338. (PMID: 35104070) Comment in: Obstet Gynecol. 2022 Feb 1;139(2):338-339. (PMID: 35104071) Erratum in: Obstet Gynecol. 2022 Feb 1;139(2):344. (PMID: 35104076) |
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| المشرفين على المادة: | 0 (Anticoagulants) 9005-49-6 (Heparin) |
| تواريخ الأحداث: | Date Created: 20211008 Date Completed: 20211217 Latest Revision: 20220214 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1097/AOG.0000000000004521 |
| PMID: | 34623065 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1873-233X |
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| DOI: | 10.1097/AOG.0000000000004521 |