ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -7 مورد

Synopsis of selected guidelines for thromboprophylaxis in patients undergoing cesarean birth

Synopsis of selected guidelines for thromboprophylaxis in patients undergoing cesarean birth
ACCP[1] SMFM[2] ACOG[3]
Recommendations
  1. Patients at low VTE risk (ie, no risk factors for VTE other than cesarean birth): Early ambulation.
  2. Patients at increased VTE risk:
    • Pharmacologic thromboprophylaxis (prophylactic LMWH) while in the hospital following delivery.
    • If anticoagulation is contraindicated, use mechanical prophylaxis (elastic stockings or intermittent pneumatic compression) while in the hospital following delivery.
  3. Patients at very high VTE risk:
    • Prophylactic LMWH plus elastic stockings and/or intermittent pneumatic compression while in the hospital following delivery.
    • If significant risk factors persist postpartum, prophylaxis is continued for up to 6 weeks following hospital discharge.
  1. All patients: sequential compression devices starting before surgery and used continuously until the patient is fully ambulatory.
  2. Patients with a previous personal history of deep venous thrombosis or pulmonary embolism: both mechanical prophylaxis (starting preoperatively and continuing until ambulatory) and pharmacologic prophylaxis (for 6 weeks postoperatively).
  3. Patients with a personal history of an inherited thrombophilia (high-risk or low-risk) but no previous thrombosis: both mechanical prophylaxis (starting preoperatively and continuing until ambulatory) and pharmacologic prophylaxis (for 6 weeks postoperatively).
  4. Class 3 obesity (BMI ≥40 kg/m2): When pharmacologic thromboprophylaxis is needed, use intermediate doses of enoxaparin.
  5. Each institution should develop a patient safety bundle and institutional protocol for VTE prophylaxis for patients undergoing cesarean delivery.
  1. All patients: Placement of pneumatic compression devices before cesarean delivery and early mobilization after cesarean delivery. Pneumatic compression devices are left in place until the patient is ambulatory.
  2. Patients with additional risk factors for thromboembolism require individual risk assessment, which may support thromboprophylaxis with pneumatic compression devices and low-molecular-weight heparin. In those with contraindications to anticoagulants, postpartum mechanical prophylaxis is advised.

Each facility should consider the risk assessment protocols available and adopt and implement one of them in a systematic way to reduce the incidence of VTE in the postpartum period.

Definitions of risk

Increased VTE risk: one major or at least two minor risk factors, except in patients undergoing emergency cesarean birth in whom one minor risk factor is sufficient.

Very high VTE risk: increased risk plus multiple additional risk factors for thromboembolism that persist in the puerperium.
   
Risk stratification
Major risk factors:
  • Immobility (strict bed rest for 1 week in the antepartum period)
  • Postpartum hemorrhage ≥1000 mL with surgery
  • Previous VTE
  • Preeclampsia with fetal growth restriction
  • Thrombophilia (antithrombin deficiency, Factor V Leiden [homozygous or heterozygous], prothrombin G20210A [homozygous or heterozygous])
  • Systemic lupus erythematosus
  • Heart disease
  • Sickle cell disease
  • Blood transfusion
  • Postpartum infection
As described above (Recommendations) and clinicians should refer to standard sources for descriptions of additional risk factors for VTE. As described above (Recommendations) and clinicians should refer to standard sources for descriptions of additional risk factors for VTE.
Minor risk factors:
  • BMI >30 kg/m2
  • Multiple pregnancy
  • Postpartum hemorrhage >1000 mL
  • Smoking >10 cigarettes/day
  • Fetal growth restriction (<25th percentile)
  • Thrombophilia (Protein C deficiency or Protein S deficiency)
  • Preeclampsia
   
ACCP: American College of Chest Physicians; ACOG: American College of Obstetricians and Gynecologists; BMI: body mass index; LMWH: low molecular weight heparin; SMFM: Society for Maternal-Fetal Medicine; VTE: venous thromboembolism.
References:
  1. Bates SM, Greer IA, Middledorp S, et al. VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141(Suppl):e691S.
  2. Pacheco LD, Saade G, Metz TD. Society for Maternal-Fetal Medicine Consult Series #51: Thromboembolism prophylaxis for cesarean delivery. Am J Obstet Gynecol 2020; 223:B11.
  3. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 196: Thromboembolism in Pregnancy. Obstet Gynecol. 2018; 132:e1. Erratum in: Obstet Gynecol. 2018 Oct;132(4):1068.
Graphic 145507 Version 1.0