title: Thromboprophylaxis following cesarean delivery: one site prospective pilot study to evaluate the application of a risk score model.
abstract: BACKGROUND
  Venous thromboembolism (VTE) remains an important cause of maternal mortality and morbidity. Cesarean delivery (CD) is a known risk factor for VTE. Data from clinical trials of thomboprophylaxis following CD are lacking and current guidelines are based on experts opinion. Our aim was to assess the efficacy of a risk score model, established at our institution, in preventing CD-related VTE.
  
  
  METHODS
  Before undergoing CD women received a risk score assessment based on age, weight, history of thrombosis, thrombophilia, immobility, parity and varicose vein. Women at moderate-high risk received pharmacological prophylaxis; all patients wore antithrombotic stockings. They had a visit before discharge and were advised to come back for visit and ultrasound if required. All received a follow-up phone call after three months.
  
  
  RESULTS
  501 consecutive women were included in the study; 233 (46.5%), at low risk, had no pharmacological prophylaxis; one of them developed a symptomatic leg deep vein thrombosis (DVT); 268 (53.5%), at moderate-high risk, received enoxaparin and none of them developed VTE. Two were lost at follow up. The incidence of DVT was 1/499 (0.2%; 95%CI 0-1.1%). The differences in major and minor bleeding were not significant between women who received or not prophylaxis respectively (1/267 vs 1/232, p=1 and 3/267 vs 1/232, p=0.62).
  
  
  CONCLUSIONS
  The risk score model applied proved effective in avoiding pharmacological prophylaxis in almost half of women and safe, since the rate of failure resulted very low (0.2%, C.I.95 0-1.1%) and there were not significant differences in bleeding in the two groups.
authors.affiliation: Department of Angiology and Blood Coagulation, S.Orsola-Malpighi University Hospital, Bologna, Italy. stefania.cavazza@aosp.bo.it
authors.forename: Stefania
authors.initials: S
authors.lastname: Cavazza
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Rainaldi
authors.forename: Angelina
authors.initials: A
authors.lastname: Adduci
authors.forename: Gualtiero
authors.initials: G
authors.lastname: Palareti
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D003661:Decision Support Techniques; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007558:Italy; D008875:Middle Aged; D018579:Patient Selection; D010865:Pilot Projects; D006473:Postpartum Hemorrhage / Q000209:etiology; D011247:Pregnancy; D011292:Premedication; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D053828:Stockings, Compression; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight