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Obstetrics & Gynecology 2005;106:733-740
© 2005 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Thromboprophylaxis After Cesarean Delivery

A Decision Analysis

Joanne N. Quiñones, MD1,2, Denise N. James, MD, MPH3, David M. Stamilio, MD,MSCE1,2, Kirsten Lawrence Cleary, MD, MSCE4 and George A. Macones, MD,MSCE1,2

From the 1Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; 2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; 3Department of Obstetrics and Gynecology and Women's Health, University of Medicine and Dentistry of New Jersey, Newark, New Jersey; and 4Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University, New York, New York.

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.

CONCLUSION: 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.




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