7 Steps for VTE Prevention in Hospitalized Pregnant Women

A recent study reported that pregnant women who were admitted to the hospital for reasons other than delivery had a significantly increased risk of blood clots.¹ The major findings of this British study, which evaluated more than 200,000 pregnant women, were startling.

Compared with non-pregnant women, the risk of venous thromboembolism (VTE) is:
- Four times higher for pregnant women whose hospital stay was less than 3 days (adjusted incidence rate ratio, 4.05; 95% CI, 2.23-7.38).
- Almost 6 times more for women admitted in their third trimester either during or after hospital admission (961 per 100,000 person-years; adjusted incidence rate ratio, 5.57; 95% CI, 3.32-9.34).
- Six times higher for pregnant women during the 28 days after hospital discharge (676 per 100,000 person-years; adjusted incidence rate ratio, 6.27; 95% CI, 3.74-10.5).

These findings have significant implications and should change treatment for pregnant women during a hospital stay for reasons other than delivery and post-discharge.

In 2011, The American College of Obstetricians and Gynecologists (ACOG) issued recommendations to reduce maternal mortality due to blood clots.² However, these recommendations focused on women admitted to the hospital for delivery.

Implications for Practice Change
Clinicians need to revise the timing of when the risk assessment for VTE occurs and document the assessment. As a reminder, a clinical alert should be placed in the EHR to signify that all hospital admissions of pregnant women for any reason require greater scrutiny for VTE and rigorous VTE risk assessment. This action would help ensure all preventative prophylactic measures are initiated.

I’m wondering what is your immediate reaction to these findings and what will it take for our hospitals to react?

As a practicing clinician, I realize it takes time and energy to change practice. However, if adopted, I believe that these 7 action steps could lessen the risk of VTE in pregnant women:

• Focus on assessment and review the obstetric VTE risk assessment currently in place.
• Ensure that VTE risk reassessment of pregnant women is occurring for every pregnant woman admitted to the hospital.
• Identify patients at risk for VTE.
• Utilize VTE prevention prophylaxis, and make sure these are adhered to in “real time.”
• Communicate practice changes to the OB clinicians as well as hospital administration and get “buy in” for changes to ensure all OB admissions for any reason are captured, noting in particular those admitted for a nondelivery diagnosis.
• Proactively approach all discharge planning so that pregnant woman are provided with a VTE prevention plan and the necessary prophylaxis for up to 28 days post discharge.
• Communicate with the patient’s other healthcare providers about the use of proper VTE prevention as consistently as you would for medication reconciliation.

The above steps should help ensure proper transition of care and prevention of hospital readmission or adverse harm events. The clinical outcome should then become apparent to the hospital in terms of improved patient outcomes and prevention of maternal harm events.

References:

1. Sultan AA, West J, Tata LJ, et al. Risk of first venous thromboembolism in pregnant women in hospital: population-based cohort study from England. BMJ. 2013;doi:10.1136/bmj.f6099.
2. Practice bulletin no. 123: thromboembolism in pregnancy. Obstet Gynecol. 2011;118:718-729.