Postpartum Outcomes in Patients Receiving Venous Thromboembolism Prophylaxis during Antepartum Admission

Muhan Hu; Christina T. Blanchard; Angela R. Seasely; Michelle Lu; Jeff M. Szychowski; Brian Casey; Alan T. Tita; George Saade; Akila Subramaniam

doi:10.1055/s-0044-1785672

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2024; 41(15): 2053-2062
DOI: 10.1055/s-0044-1785672

Original Article

Postpartum Outcomes in Patients Receiving Venous Thromboembolism Prophylaxis during Antepartum Admission

Muhan Hu

¹Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

,

Christina T. Blanchard

¹Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

²Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama

,

Angela R. Seasely

³Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

,

Michelle Lu

¹Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

,

Jeff M. Szychowski

²Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama

⁴Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama

,

Brian Casey

³Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

,

Alan T. Tita

³Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

,

George Saade

⁵Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas

,

Akila Subramaniam

³Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

› Institutsangaben

Abstract

Objective We evaluated if venous thromboembolism (VTE) prophylaxis in the inpatient antepartum period was associated with wound hematomas, VTE occurrence, and other adverse outcomes.

Study Design This study is a secondary analysis of a retrospective cohort of patients who delivered at University of Alabama at Birmingham (UAB). Patients receiving outpatient anticoagulation (AC) were excluded. We grouped patients into those who received inpatient antepartum prophylactic AC and those who did not. The primary outcome was wound hematomas from delivery to 6 weeks postpartum (PP). Secondary outcomes included VTE occurrence and select adverse outcomes, including other wound complications, unplanned procedures, mode of anesthesia, and intensive care unit (ICU) admission. Analyses were performed with no AC group as the reference. A sensitivity analysis excluding those who received inpatient PP AC was performed.

Results Of 1,035 included patients, only 169 patients received inpatient prophylactic AC. They were older, had higher body mass indices, and more comorbidities. Patients receiving inpatient antepartum AC had higher wound hematomas (adjusted odds ratio [aOR] 23.81; 95% confidence interval [CI] 7.04–80.47). They had similar risk for developing VTE as the control group (aOR 2.68; 95% CI 0.19–37.49) but were more likely to have wound complications (aOR 2.36; 95% CI 1.24–4.47), maternal deaths (p < 0.05), and require PP ICU admission (aOR 13.38; 95% CI 4.79–37.35). When excluding those receiving any PP AC, there was no difference in bleeding complications between the two groups and VTE rates remained unchanged. Rates of maternal deaths and PP ICU admissions remained higher in those who received inpatient antepartum AC prophylaxis.

Conclusion In this small cohort study, increased wound hematomas were found in those who received inpatient antepartum AC prophylaxis with no difference in VTE occurrence. While adverse events were increased in the inpatient AC group, this was mostly associated with PP AC prophylaxis. Larger studies should be conducted to describe the true benefits and risks of antepartum AC prophylaxis and determine efficacy of this widely used practice.

Key Points

Peripartum chemoprophylaxis is associated with increased wound hematomas.
VTE is rare, despite its association with significant peripartum morbidity/mortality.
Large studies are needed to guide practices that optimize the risk/benefit ratio of chemoprophylaxis.

Keywords

anticoagulation - chemoprophylaxis - venous thromboembolism - antepartum - inpatient - adverse outcomes

Volltext

Referenzen

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