Risk Stratification and Prophylaxis of Venous Thromboembolic Events in Obstetrics

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Elliot M. Levine

Illinois Masonic Medical Center, USA

: Androl Gynecol: Curr Res

Abstract

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Objective: To identify the risk factors for perioperative venous thromboembolism, and the possible consequences of chemical thromboprophylaxis used with cesarean delivery. Study Design: An Enterprise Data Warehouse (EDW) of a multi-hospital system was queried to obtain the incidence of and risk factors for perioperative venous thromboembolism (VTE) and the use of chemical thromboprophylaxis (CTP). Results: Of 337,174 surgical patients over the course of 2010-2013, Cesarean Delivery (CD) occurred 24,608 times, with chemical VTE prophylaxis being provided 931 times and 23,677 times without such prophylaxis. CTP was provided a total of less than 4% of the time. Hemorrhagic complications were recorded 0.08% of the time (0.2% when CTP was provided, and 0.07% without it). Though this was not found to be a statistically significant difference (p = .13), it may still warrant our concern, regarding the appropriateness of using CTP for all cesarean deliveries. Conclusion: Chemical thromboprophylaxis may have the risk of associated hemorrhage with its use, and it may be worthwhile to use risk stratification to decide whether or not to use it for surgical prophylaxis in particular cesarean cases.

Biography

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Elliot M. Levine received his Bachelor of Science from the University of Wisconsin at Madison in 1974 and his MD from the Chicago Medical School in 1978 and completed his Residency in Obstetrics and Gynecology at Illinois Masonic Medical Center in 1982. He has been Board Certified in Obstetrics & Gynecology continuously since 1984. He is a member of a number of medical societies including the American College of Obstetricians and Gynecologists, the Chicago Gynecological Society, the Central Association of Obstetricians and Gynecologists, and the American Medical Informatics Association, to name a few. His involvement in research, education and Quality Assurance has allowed him to author numerous articles in medical journals, leading him to often lecture to physician audiences. He has served as Director of Informatics and Research in a Department of Obstetrics & Gynecology for well over a decade and as a Physician Director for the implementation of an Electronic Medical Record System in a large healthcare system. He continues to have a general gynecology practice, and has been listed in America’s Top Doctors for over a decade.