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Prevention of Postpartum Venous Thromboembolism

Clinton, Chelsea M. MD*; Kuller, Jeffrey A. MD; James, Andra H. MD, MPH

Obstetrical & Gynecological Survey: October 2019 - Volume 74 - Issue 10 - p 601–606
doi: 10.1097/OGX.0000000000000714
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Importance Postpartum venous thromboembolism (VTE) results in significant morbidity and mortality. The practicing obstetrician-gynecologist should have a plan for management and prevention.

Objective The objective of this review is to familiarize obstetric providers with available evidence regarding postpartum VTE prevention and suggest a clinical practice guideline.

Evidence Acquisition Published literature was retrieved through a search of PubMed and relevant review articles, original research articles, systematic reviews, and practice guidelines.

Results Thromboembolic disease is one of the leading causes of maternal death in developed nations. Current evidence does not support universal postpartum VTE prophylaxis. Risk factor stratification is suggested to identify patients at high risk of VTE. Recent guidelines have recommended complex algorithms that are difficult to put into practice and have not been validated in the postpartum state. The American College of Obstetricians and Gynecologists has recommended that each institution develop a protocol to identify and treat women at high risk of postpartum VTE.

Conclusions and Relevance Obstetric providers should be familiar with available evidence and best practice regarding postpartum VTE prevention. A suggested clinical practice guideline for the prevention of postpartum VTE is provided.

Target Audience Obstetricians and gynecologists, family physicians.

Learning Objectives After participating in this activity, the learner should be better able to summarize the literature pertinent to postpartum VTE prophylaxis; identify patients at high risk of postpartum VTE through risk stratification; and select appropriate VTE prophylaxis based on individual patient risk factors.

*Fellow

Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC

All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this educational activity.

Correspondence requests to: Chelsea M. Clinton, MD, 2608 Erwin Rd, Suite 210, Durham, NC 27705. E-mail: Chelsea.clinton@duke.edu.

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