Abstract
Background
National guidelines have been developed to ensure correct dosing of tinzaparin for women delivered by caesarean delivery (CD) to reduce the risk of venous thromboembolism.
Aims
The aim of this study is to examine the impact of implementation of national guidelines on thromboprophylaxis prescribing practice for women undergoing CD in a university maternity hospital.
Methods
Details of tinzaparin usage were obtained from the Hospital pharmacy for the years 2009–2014. Information on CD and pulmonary embolism (PE) were obtained from the Hospital’s annual clinical reports.
Results
Following guideline recommendations on weight-based tinzaparin for all women undergoing CD, the usage of syringes prefilled with tinzaparin 4500 IU increased from 526 to 8502 (P < 0.001) and usage of syringes prefilled with tinzaparin 10,000 IU increased from 36 to 910 (P < 0.001). Usage of syringes prefilled with tinzaparin 3500 IU decreased from 8216 in 2009 to 39 in 2014 (P < 0.001). During 2008–2010, there were two cases of PE after CD, both of whom received an inadequate dose of prophylactic tinzaparin. During 2011–2014 there were no cases of PE diagnosed after a total of 9427 CDs.
Conclusions
The development of national guidelines on thromboprophylaxis after CD was followed by a significant change in weight-based prescribing of tinzaparin. Following implementation, there have been no cases of PE after CD.
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References
Knight M, Kenyon S, Brocklehurst P et al, editors, on behalf of MBRRACE-UK (2014). Saving lives, improving mothers’ care—lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–12. National Perinatal Epidemiology Unit, University of Oxford, Oxford
Greer IA (1999) Thrombosis in pregnancy: maternal and fetal issues. Lancet 353:1258–1265
Mismettti P, Laporte S, Darmon JY et al (2001) Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery. Br J Surg 88:913–930
Greer IA, Nelson-Piercy C (2005) Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 106:401–407
Royal College of Obstetricians and Gynaecologists (2009). Reducing the risk of thrombosis and embolism during pregnancy and the puerperium. Green-top Guideline 37a. Royal College of Obstetricians and Gynaecologists, London. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg37areducingriskthrombosis.pdf. Accessed 21 March 2016
Kennedy C, O’Dwyer V, O’Kelly S et al (2012) Thromboprophylaxis for women undergoing caesarean section. Ir Med J 105:56–57
Royal College of Physicians of Ireland, Institute of Obstetricians and Gynaecologists (2011) Obesity and pregnancy, Clinical Practice Guideline No. 2. Royal College of Physicians of Ireland, Dublin http://www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/guideobesity.pdf. Accessed 21 March 2016
Royal College of Physicians of Ireland, Institute of Obstetricians and Gynaecologists (2013) Venous thromboprophylaxis in pregnancy. Clinical practice guideline no. 20. Royal College of Physicians of Ireland, Dublin http://www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/vte.pdf. Accessed 21 March 2016
Coombe Women Infants University Hospital (2015). Annual Clinical Report 2014. HSE Press, Dublin
Lynch CM, Kearney R, Turner MJ (2003) Maternal morbidity after elective repeat caesarean section after two or more previous procedures. Eur J Obstet Gynecol Reprod Biol 106:10–13
Pai M, Lloyd NS, Cheng J et al (2013) Strategies to enhance venous thromboprophylaxis in hospitalized medical patients (SENTRY): a pilot cluster randomized trial. Implement Sci 8:1
Chaillet N, Dubé E, Dugas M et al (2006) Evidence-based strategies for implementing guidelines in obstetrics. Obstet Gynecol 108:1234–1245
Grol R (2001). Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care 39: II-46-II-54
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As a retrospective study of routinely gathered hospital pharmacy dispensing data, this article does not contain any studies with human participants or animals performed by any of the authors.
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Maguire, P.J., McGuire, M., Power, K.A. et al. Tinzaparin thromboprophylaxis prescribing practice after caesarean delivery 2009–2014. Ir J Med Sci 187, 123–126 (2018). https://doi.org/10.1007/s11845-017-1619-7
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DOI: https://doi.org/10.1007/s11845-017-1619-7