title: Rate of wound complications with enoxaparin use among women at high risk for postpartum thrombosis.
abstract: OBJECTIVE
  To estimate the rate of wound complications associated with protocol-driven postcesarean enoxaparin thromboprophylaxis.
  
  
  METHODS
  After implementing an Institutional Clinical Practice Guideline for postoperative cesarean delivery thromboprophylaxis among at-risk gravid women (older than 35 years of age, body mass index greater than 30 kg/m2, or both), data on all cesarean deliveries over the first 23 months of guideline implementation were extracted and analyzed. Primary (wound hematoma, separation, or dehiscence) and secondary (venous thromboembolism) outcomes were compared in stratified and multivariable models controlling for potential confounders.
  
  
  RESULTS
  Over 23 months, 2,509 cesarean deliveries were performed. A total of 1,677 (68%) gravid women met criteria for thromboprophylaxis; 653 received enoxaparin per protocol ("cases"), and, at the discretion of the ordering physician, 1,024 did not (at-risk, protocol-noncompliant "controls"). Cases differed significantly by virtue of maternal age, body mass index, and diabetic status. Univariable analysis subsequently revealed a higher rate of wound separation (6.8% compared with 3.6%, P=.003), rehospitalization (2.1% compared with 0.8%, P=.017) and composite score (8.9% compared with 4.8%, P=.002) among protocol-compliant cases, but no increased risk of wound hematoma (P>.06). In multivariable analysis, adjusted odds ratios continued to reveal an association between enoxaparin use and wound separation (OR 1.66, P=.04) as well as higher composite score (OR 1.69, P=.01). However, among the protocol-noncompliant controls, a nonsignificant increase in the rate of venous thromboembolism occurred.
  
  
  CONCLUSIONS
  In our series, prophylactic enoxaparin use among at-risk gravid women undergoing cesarean delivery was accompanied by an increased risk of wound separation.
  
  
  METHODS
  II.
authors.affiliation: From the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine; and Ben Taub General Hospital, Harris County Hospital District, Houston, Texas.
authors.forename: Millie A
authors.initials: MA
authors.lastname: Ferres
authors.forename: Sofia A
authors.initials: SA
authors.lastname: Olivarez
authors.forename: Victoria
authors.initials: V
authors.lastname: Trinh
authors.forename: Christina
authors.initials: C
authors.lastname: Davidson
authors.forename: Haleh
authors.initials: H
authors.lastname: Sangi-Haghpeykar
authors.forename: Kjersti M
authors.initials: KM
authors.lastname: Aagaard-Tillery
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D002585:Cesarean Section; D017984:Enoxaparin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D011644:Puerperal Disorders / Q000517:prevention & control; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000139:chemically induced*; D013927:Thrombosis / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin