A Comparison of Peripartum Scoring Systems of Anticoagulation for Venous Thromboembolic Prophylaxis [4K]. (May 2017)

• Record Type: Journal Article
• Authors: Orfanelli, Theofano; Awomolo, Adeola; Gomez, Daniela; Doulaveris, Georgios; Duzyi, Christina
• Is Part Of: Obstetrics and gynecology. Volume 129 (2017)Supplement 1
• Publication Date: 2017-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000514597.17570.79
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: Postpartum VTE is rare (0.16%), however, its potential for mortality make it an important focus for intervention. The American College of Obstetricians and Gynecologists (the College) and the Royal College of Obstetricians & Gynaecologists (RCOG) have proposed scoring guidelines for antepartum (AP) and postpartum (PP) prophylaxis. Threshold scores for treatment have not been validated. Our study compared the potential impact of these scoring thresholds at a regional perinatal center. METHODS: We conducted a retrospective cohort study of patients admitted for maternity care over 4 months. Each patient was assigned an AP and PP risk score using both guidelines. Any VTE occurring up to 6 weeks postpartum was obtained by a review of the medical records. Fischer's exact test was used for categorical variables. RESULTS: 311 women were included in our study. Using the RCOG scoring thresholds 29.2% of AP patients would require treatment compared to 10.9% of women when using the College guidelines (p < 0.001). Similarly for PP patients, 124 women (39.9%) would require treatment based on the RCOG guidelines compared to 63 women (20.3%) when using the College guidelines (p < 0.001). If prophylaxis were performed at a threshold score of 3 instead of 2 for PP patients by College criteria, 28 women (9%) would be treated. CONCLUSION: Significantly more patients would require prophylactic anticoagulation treatment based on the RCOG guidelines. Utilizing College guidelines and increasing the threshold for treatment would facilitate targeting patients at risk without an excessive burden of increased cost and complication rate to the global patient population.