ArticleAmerican journal of perinatology2026
Postpartum Pharmacologic Thromboprophylaxis Guideline Adherence and Post-Delivery Complications: A Single-Center, Retrospective Cohort Study.
Article in American journal of perinatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
4 authors.
Funding
Abstract
Objective: Obstetric and anesthesia guidelines provide differing recommendations for the timing of initiation of postpartum pharmacologic thromboprophylaxis relative to delivery time, mode of delivery, and anesthesia type and administration time. We aimed to (1) describe the rate of adherence to obstetric (OB) and anesthesia (ANE) guidelines for timing of postpartum pharmacologic thromboprophylaxis initiation, (2) assess trends in adherence over time, and (3) evaluate the association between guideline adherence and venous thromboembolism (VTE) and complications. Study Design: Retrospective cohort of patients delivering at a single academic center from 2015 to 2023 receiving postpartum low-molecular-weight heparin (LMWH) prophylaxis. Those with an antepartum VTE or on therapeutic anticoagulation were excluded. The primary outcome was guideline adherence. OB guideline adherence was defined as LMWH initiation within 4 to 6 hours after vaginal, or 6 to 12 hours after cesarean, delivery. ANE guideline adherence was defined as LMWH initiation ≥12 hours post-neuraxial ANE placement and ≥4 hours post-neuraxial removal. Secondary outcomes included VTE, readmission, reoperation, and wound complications within 6 weeks postpartum. The rate of adherence to guidelines and trends in adherence were assessed. Multivariable models estimated the association between guideline adherence and secondary outcomes. Results: Of the 5,959 included patients, 3,952 (66.3%) underwent cesarean delivery. Overall, 926 (15.5%) were OB guideline adherent, 4,800 (80.6%) ANE guideline adherent, and 488 (8.2%) both OB and ANE adherent. Guideline adherence increased over time ( Conclusion: Adherence to OB guidelines for timing of postpartum pharmacologic prophylaxis was low, while adherence to ANE guidelines was much higher. OB, ANE, or both guideline adherence was not associated with lower rates of VTE or complications. Key Points: · Adherence to obstetric guidelines was low (16%).. · Adherence to anesthesia guidelines was high (81%).. · Frequency of VTE did not differ by guideline adherence..
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Registered trials
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