title: Underuse of postcesarean thromboembolism prophylaxis.
abstract: OBJECTIVE
  To characterize contemporary practice patterns for postcesarean thromboembolism prophylaxis and determine whether opportunities to substantially decrease maternal mortality and morbidity in this clinical setting are being missed.
  
  
  METHODS
  A commercial hospitalization database that includes procedure and diagnosis codes, health care provider and hospital information, and patient demographic data were used to analyze use of venous thromboembolism prophylaxis after cesarean delivery in the United States between 2003 and 2010. The analysis evaluated whether patients received pharmacologic prophylaxis, mechanical prophylaxis, combined prophylaxis, or no prophylaxis. Hospital-level factors and patient characteristics were included in multivariable regression models evaluating prophylaxis administration.
  
  
  RESULTS
  We identified 1,263,205 women who underwent cesarean delivery. Within the cohort, 75.7% (n=955,787) received no thromboembolism prophylaxis, 22.1% (n=278,669) received mechanical prophylaxis alone, 1.3% (n=16,639) received pharmacologic prophylaxis, and 1.0% (n=12,110) received combination prophylaxis. The rate of prophylaxis increased from 8.4% in 2003 to 41.6% in 2010. Prophylaxis rates varied significantly by geographic region. Medical risk factors for thromboembolism were associated with only modest increases in prophylaxis.
  
  
  CONCLUSIONS
  Although our findings demonstrated increased adoption of postcesarean venous thromboembolism prophylaxis, fewer than half of patients received recommended care as of 2010, and significant variation was present. Thromboembolism prophylaxis is underused and represents a major opportunity to reduce maternal morbidity and mortality. Risk assessment tools and thromboprophylaxis guidelines are needed to assure high-quality, uniform care.
  
  
  METHODS
  : III.
authors.affiliation: Divisions of Maternal Fetal Medicine and Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, and the Department of Epidemiology, Joseph J. Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Friedman
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.forename: Yu-Shiang
authors.initials: YS
authors.lastname: Lu
authors.forename: Mary E
authors.initials: ME
authors.lastname: D'Alton
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
mesh_terms: D000328:Adult; D000367:Age Factors; D000925:Anticoagulants / Q000627:therapeutic use; D002585:Cesarean Section / Q000009:adverse effects*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D044469:Racial Groups; D018570:Risk Assessment; D012307:Risk Factors; D053828:Stockings, Compression / Q000706:statistics & numerical data; D014481:United States; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants