Better Education on VTE Prevention Is Needed

The results of a recent study of expectant mothers underscore the need for improved awareness among caregivers about how to best protect patients from clots before delivery.¹

Blood clots continue to be a leading cause of maternal death in the United States.² According to recommendations from The American College of Obstetricians and Gynecologists (ACOG), most instances of venous thromboembolism (VTE) or blood clots in pregnant women occur within the deep veins of the left leg.³

Patients delivering by cesarean section and those admitted to high-acuity fetal monitoring hospital units before delivery are at significantly higher risk for VTE. As a result, ACOG recommends that these patients not already receiving prophylaxis should be fitted with vascular compression devices,³ which have been described as “a safe, potentially cost-effective preventative intervention” by Andra H. James, MD, who helped develop ACOG’s guidelines.⁴

In the wake of ACOG’s recommendations, the Saint Louis University School of Medicine conducted a study to evaluate compliance for two types of sequential compression devices (SCDs)-foot cuffs and leg sleeves-in the prevention of VTE in antepartum (prior to childbirth) patients.¹ The results of the study were presented at ACOG’s 61st Annual Clinical Meeting held earlier this year.

The study included more than 900 patients, of which 574 were fitted with leg sleeve SCDs and 333 were fitted with foot sleeve SCDs. Although the leg sleeve group had a slightly higher average body mass index than the foot sleeve group, the patients’ demographics were otherwise similar.

Among the study’s key findings:
•    For patients admitted to higher-acuity fetal monitoring hospital units and wearing either of the two SCDs, compliance improved in comparison with patients in low-acuity antepartum units (devices were in place, P<0.001; devices were in place and functioning, P<0.001).
•    In fetal monitoring hospital units, the compliance for patients with foot sleeves was higher than the compliance for patients with leg sleeves (devices were in place, P=0.001; devices were in place and functioning, P=0.002).

Although the study found that overall SCD compliance was poor, as Thinh P. Nguyen, MD, who led the Saint Louis University study points out, “compliance with foot pump SCDs was greater than with leg cuff SCDs in the high-acuity fetal monitoring unit, which suggests that patients may find foot pump SCDs to be easier to use.”

Moreover, concludes Dr. Nguyen, the study demonstrates the need for better awareness and education about how VTE can be prevented, managed, and treated during pregnancy.

“Considering that VTE is the leading cause of maternal morbidity in the nation, it was disheartening when our study found overall SCD compliance to be poor,” Dr. Nguyen said. “As recent recommendations issued by ACOG advise, SCDs are a low cost and effective preventive intervention. Clearly, there’s is a need for improved attention about VTE intervention and the role of SCDs in that intervention not only among healthcare professionals but among the general public and particularly expectant mothers.”

References:

1. Nguyen TP, Dickert EJ, Goodwin J, Gross GA. A comparison of sequential compression device compliance in an antepartum population. Poster presented at: American College of Obstetricians and Gynecologists 61st Annual Clinical Meeting; May 6, 2013; New Orleans.
2. Khan KS, Wojdyla D, Say L, et al. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066-1074.
3. Practice bulletin 123: thromboembolism in pregnancy. Obstet Gynecol. 2011;118:718-729.
4. Barclay L. ACOG issues guidelines to prevent thromboembolic events. August 26, 2011. Available here. Accessed October 28, 2013.