Thromboprophylaxis After Cesarean Delivery

Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 11/2005; 106(4):733-40. DOI: 10.1097/01.AOG.0000178792.51401.3a
Source: PubMed


To compare 4 strategies for managing patients after cesarean delivery.
Using decision analysis, we compared universal subcutaneous (SC) heparin prophylaxis, heparin prophylaxis only for patients with a genetic thrombophilia, use of pneumatic compression stockings (PCS), and no thromboprophylaxis. Outcomes included heparin-induced thrombocytopenia (HIT), HIT-related thrombosis, major maternal bleeding, and venous thromboembolism (VTE).
Use of PCS was the strategy with the lowest number of adverse events. With heparin prophylaxis, 13 cases of HIT-induced thrombosis and hemorrhage would occur per VTE prevented. When heparin prophylaxis is administered only to thrombophilia-positive women, 1.2 cases of HIT-induced thrombosis and bleeding would occur per VTE prevented. In sensitivity analyses, the model was stable across virtually all variable ranges.
Use of PCS after cesarean delivery is the strategy with the lowest number of adverse events. Universal prophylaxis with SC heparin is associated with an excess risk of HIT-induced thrombosis and bleeding per VTE prevented compared with PCS use. Until future studies are completed, postcesarean thromboprophylaxis with PCS should be used if the clinician elects to provide prophylaxis.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Decision analysis is a type of study design that can help to explicitly compare different medical choices and provide additional perspective to information provided by observational and interventional studies. This review will detail the circumstances under which decision analysis is most appropriate to use and the conceptual approach to the development of a decision model. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to summarize that decision analysis will: help to compare different medical choices; supply additional perspectives to information provided by observational and interventional studies; and allow comparison of medical strategies that involve health outcomes, cost, or combined cost-effectiveness measures.
    No preview · Article · Sep 2006 · Obstetrical and Gynecological Survey
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the cost-effectiveness of thromboprophylaxis at cesarean delivery with intermittent pneumatic compression. A decision tree model using Markov analysis was developed to compare two approaches to perioperative care at the time of cesarean delivery: 1) no use of perioperative thromboprophylaxis and 2) the use of intermittent pneumatic compression for thromboprophylaxis at the time of cesarean delivery. Postcesarean deep venous thrombosis was estimated to occur in 0.7% of patients (75% of whom were asymptomatic), and result in a 9% chance of postthrombotic syndrome. Mechanical prophylaxis was assumed to decrease the risk of deep venous thrombosis by 70% and to cost 120 dollars. Probability of morbidity and mortality of venous thromboembolism as well as anticoagulation and the costs and utilities for different health state were derived from published studies. Sensitivity analysis was performed over a wide range of variable estimates. Using the assumptions in our base case, routine thromboprophylaxis for cesarean delivery cost 39,545 dollars per quality-adjusted life year. One-way sensitivity analysis revealed that as long as the incidence of postcesarean deep venous thrombosis was at least 0.68%, intermittent pneumatic compression reduced the incidence of deep venous thrombosis by at least 50%, or the cost of intermittent pneumatic compression was less than 180 dollars, the cost-effectiveness of mechanical prophylaxis did not exceed 50,000 dollars per quality-adjusted life year. Mechanical thromboprophylaxis is estimated to be a cost-effective strategy under a wide range of circumstances.
    No preview · Article · Oct 2006 · Obstetrics and Gynecology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Management of the pregnant patient requiring anticoagulation in the peripartum period represents a significant clinical challenge. The peripartum period includes the most thrombogenic pregnancy-associated state and the intrapartum and immediate postpartum periods, when hemorrhage is and important concern. Clinical decisions depend on the type of antepartum anticoagulation, obstetric factors, risk of hemorrhage, and the risk and implications of thrombosis.
    No preview · Article · Oct 2006 · Obstetrics and Gynecology Clinics of North America
Show more