Prophylactic, intermediate-, and adjusted-dose regimens are listed in Table 52-5 (p. 1013).
of high quality data" described earlier by Bates and colleagues compression devices before cesarean delivery for all women (2016) creates considerable variation in the current recommennot already receiving thromboprophylaxis. his recommendations promulgated by the American College of Obstetricians dation was based primarily on consensus and expert opinion. and Gynecologists, the Royal College of Obstetricians, and the For patients undergoing cesarean delivery with additional risk American College of Chest Physicians (Palmero la, 2016). factors for thromboembolism, both pneumatic compression
In 2011, the American College of Obstetricians and Gynedevices and UFH or LMH may be recommended. he Colcologists (20 17b) recommended placement of pneumatic lege stipulated that cesarean delivery in an emergency setting should not be delayed because of the time necessary to implement thromboprophylaxis. Implementation of this strategy by the Hospital Corporation of America, the largest for-profit obstetrical health care delivery system in the United States, was associated with a reduction in deaths from pulmonary embolism from 7 of 458,097 cesarean births to 1 of 465,880 cesarean births (Clark, 2011, 2014).
In 2016, the National Partnership for Maternal Safety published several consensus recommendations for the prevention of maternal TE (D'lton, 2016). These recommendations included expanded use of antenatal prophylaxis for women hospitalized 3 days or longer, expanded use of prophylaxis during and after vaginal delivery, and expanded use of pharmacological prophylaxis to most women after cesarean delivery. In response, Sibai and Rouse (2016) expressed concern that these new recommendations derive from sparse data of questionable applicability to obstetrical patients. They called for better quality evidence to measure the benefits, harms, and costs of increased pharmacological thromboprophylaxis. As aptly expressed by Macones (2017), "an intervention, such as increased postcesarean pharmacologic thromboprophylaxis, where there are legitimate concerns about eicacy and safety, requires a much higher degree of evidence before a national guideline is implemented." We agree with these sentiments.
Agnelli G, Becattini C, Kirschstein T: Thrombolysis vs heparin in the treatment of pulmonary embolism. Arch Intern Med 162: 2537, 2002
Ahearn GS, Hadjiliadis 0, Govert JA, et al: Massive pulmonary embolism during pregnancy successfully treated with recombinant tissue plasminogen activator. Arch Intern Med 162: 1221, 2002
Akazawa M, Nishida M: Thrombolysis with intravenous recombinant tissue plasminogen activator during early postpartum period: a review of the literature. Acta Obstet Gynecol Scand 96(5):529, 2017
Almawi Y, AI-Shaikh FS, Melemedjian OK, et al: Protein Z, an anticoagulant protein with expanding role in reproductive biology. Reproduction 3,t2013