A Extra Selective Enoxaparin Thromboprophylaxis Protocol Would possibly possibly Be Safer for Original Moms

A extra selective chance-stratified ability to postpartum enoxaparin (Lovenox) thromboprophylaxis for venous thromboembolism (VTE) used to be linked to diminished rates of harm hematomas with out rising the velocity of VTE, in step with a retrospective observational stare conducted at a tall referral heart.

Among over 17,000 patients, the extra selective enoxaparin protocol used to be linked with a low cost in harm hematomas compared with the distinctive standard protocol (0.3% vs 0.7%; adjusted OR 0.38, 95% CI 0.21-0.67), reported a neighborhood led by Macie Champion, MD, of the College of Alabama at Birmingham (UAB).

This revenue used to be pushed largely by a 50% decrease fee of superficial harm hematomas (0.3% vs 0.6%, respectively; aOR 0.43, 95% CI 0.24-0.75), they effectively-known in JAMA.

The selective protocol used to be also linked with fewer harm complications of any model (1.4% vs 2.0%; aOR 0.66, 95% CI 0.50-0.86).

Within the intervening time, the institution saw no alternate in incidence of VTE — particularly, deep venous thrombosis or pulmonary thromboembolism, or every other VTE — between the distinctive and extra selective protocols (0.008% vs 0.0014%, aOR 0.40, 95% CI 0.12-1.36).

“Given the rarity of VTE, which may possibly presumably necessitate a tall randomized trial that’s doubtless infeasible, future reports may possibly well level-headed continue to be pleased in mind chemoprophylaxis pointers to resolve the utility and safety of routine use of heparin-essentially based entirely mostly thromboprophylaxis, even in populations at greater chance of postpartum VTE,” Champion and colleagues wrote.

They outlined that UAB historically followed no pregnancy-linked anticoagulation pointers till 2016, when the institution adopted a chance-stratified enoxaparin protocol essentially based entirely totally on expert conception and observational data and suggested by organizations along side the American Faculty of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medication.

Esteem other groups, the UAB researchers noticed an design better in harm hematomas the usage of that protocol.

In 2021, the sanatorium conducted a extra selective chance-stratified ability, which used to be compared against the distinctive 2016 protocol in the new file.

The extra selective protocol contains giving enoxaparin to patients if they’ve a history of VTE or nephrotic syndrome and as a minimal three extra chance components. Other adjustments from the older protocol included:

  • Removing of preeclampsia, ages 40 and older, and thrombophilia as chance components
  • Downgrading pre-pregnancy BMI ≥40 to a secondary chance exclaim
  • Making sepsis a chance exclaim as a change of any major infection
  • Elevating the bar for systemic lupus erythematosus patients to those already taking as a minimal two medications for it

With these stricter requirements, enoxaparin administration fell from 16% to 8%.

This stare used to be essentially based entirely totally on 17,489 pregnant ladies who delivered at UAB in the end of two classes, one whereas the distinctive protocol used to be in location (2016-2018; 71%) and the opposite after implementation of the extra selective chance-stratified ability (2021-2023; 29%).

Patients receiving outpatient anticoagulation for lively VTE or belief to be high chance for VTE in the end of pregnancy had been excluded.

Between the two stare groups, patients in the extra selective protocol neighborhood had been older (28.5 vs 27.7 years), much less more doubtless to be pleased government-funded insurance (59% vs 65%), had a greater BMI (31 vs 30), had been extra more doubtless to use aspirin (23% vs 18%), and had been extra more doubtless to be identified with preeclampsia (21% vs 16%).

The stare’s major prognosis taking into account the incidence of harm hematomas going down from after transport by 6 weeks postpartum. The researchers mature multivariable logistic regression for his or her prognosis, and findings had been confirmed with propensity-matched analyses.

Particularly, ladies who underwent cesarean transport had a disproportionately low chance of harm hematomas with the extra selective protocol (aOR 0.22, 95% CI 0.11-0.46).

However, Champion and personnel cautioned that they may possibly well not absolutely address confounding given the stare’s retrospective manufacture. Whether the outcomes are generalizable to other establishments is also unclear.

“To boot, future reports may possibly well level-headed be pleased in mind the protection of more moderen oral anticoagulants in the postpartum duration, inspiring by lactation, as doable choices to heparin-essentially based entirely mostly thromboprophylaxis,” they wrote.

The major outcomes from this stare had been reported earlier this 365 days on the Society for Maternal-Fetal Medication’s annual assembly.

  • author['full_name']

    Nicole Lou is a reporter for MedPage Currently, the keep she covers cardiology news and other developments in medication. Be conscious


Champion had no disclosures.

A co-creator reported advisory board membership for Novocuff and receipt of grants from the NIH.

Main Source


Source Reference: Champion ML, et al “A extra selective vs a outmoded chance-stratified, heparin-essentially based entirely mostly, obstetric thromboprophylaxis protocol” JAMA 2024; DOI: 10.1001/jama.2024.8684.

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