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Am J Perinatol
DOI: 10.1055/a-2597-8735
Original Article

Single Center Implementation of a Postpartum Pharmacologic Thromboprophylaxis Protocol

Authors

  • Ann M. Bruno

    1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

  • Amanda A. Allshouse

    1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

  • Christine M. Warrick

    2   Division of Obstetric Anesthesia, Department of Anesthesiology, University of Utah Health, Salt Lake City, Utah

  • Torr D. Metz

    1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

Funding A.M.B. was supported by the Women's Reproductive Health Research (WRHR) K12HD085816 during the completion of this work.
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Abstract

Objective

This study aimed to evaluate trends in the frequency of pharmacologic prophylaxis following the implementation of a postpartum venous thromboembolism (VTE) prevention protocol. Secondarily, to evaluate the association between protocol implementation and incidence of VTE and complications.

Study Design

Retrospective cohort of patients delivering from 2015 to 2022 at a single academic institution. Those with an antepartum VTE or receiving therapeutic anticoagulation were excluded. An inpatient thromboprophylaxis protocol was implemented in January 2017 and further updated in July 2020 to expand risk factors to qualify for prophylaxis and extend the length of therapy to the outpatient setting (total 14 days). The cohort was divided into three time periods: preimplementation (January 1, 2025–December 31, 2016), initial protocol (January 1, 2017–June 30, 2020), and updated (July 1, 2020–December 31, 2022) protocol. The primary outcome was the receipt of inpatient heparin-based pharmacologic prophylaxis. Secondary outcomes included filling an outpatient pharmacologic prophylaxis prescription, VTE, and wound complications observed through 6 weeks postpartum. Baseline characteristics and outcomes were compared across the three protocol periods. Logistic regression modeling estimated the association between outcomes and the updated protocol period compared with prior periods.

Results

Overall, 22.6% (95% confidence interval [CI]: 22.1–23.0) of 34,217 included deliveries received inpatient pharmacologic prophylaxis: 7.7% (7.1–8.2%) preimplementation, 15.8% (15.2–16.4%) initial protocol, and 41.2% (40.4–42.1%) during the updated protocol period. The rates of inpatient and outpatient prophylaxis increased significantly over time (p < 0.001 test of trend). Delivery in the updated protocol period was not associated with differences in VTE (pre: 0.1%, initial: 0.2%, and updated: 0.1%) nor wound complications (pre: 3.4%, initial: 2.7%, and updated: 2.7%).

Conclusion

Single-center implementation of a postpartum prophylaxis protocol resulted in increased use of inpatient and outpatient pharmacologic prophylaxis without changes in rates of VTE or wound complications.

Key Points

  • Implementation of a postpartum thromboprophylaxis protocol resulted in increased rates of pharmacologic prophylaxis.

  • No differences in wound complications were observed by the protocol period.

  • Rates of VTE did not change over time.

Keywords

heparin-based thromboprophylaxis - low molecular weight heparin - maternal morbidity and mortality - postpartum thromboprophylaxis - thromboembolism - wound complications

Supplementary Material



Publication History

Received: 24 February 2025

Accepted: 30 April 2025

Accepted Manuscript online:
01 May 2025

Article published online:
21 May 2025

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