Thromboprophylaxis after cesarean delivery: a decision analysis.
OBJECTIVE
To compare 4 strategies for managing patients after cesarean delivery.


METHODS
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).


RESULTS
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.


CONCLUSIONS
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.
Quiñones
Joanne N
JN
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. jquinones@obgyn.upenn.edu
James
Denise N
DN
Stamilio
David M
DM
Cleary
Kirsten Lawrence
KL
Macones
George A
GA
D001458:Bandages; D002585:Cesarean Section / Q000009:adverse effects; D003661:Decision Support Techniques; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D011182:Postoperative Care; D011247:Pregnancy; D018570:Risk Assessment; D013923:Thromboembolism / Q000517:prevention & control; D019851:Thrombophilia / Q000150:complications / Q000175:diagnosis* / Q000235:genetics; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
D005343:Fibrinolytic Agents; D006493:Heparin