Venous Thromboembolism Sticker For Postpartum Thromboprophylaxis: Single Unit
Experience.

Jatheeswaran K1, Kalaivathanan Y1, Pinnaduwa S1, Banu AH1, Kesha SV1, Karunana Marleen FS11 Sri Jayewardenepura General Hospital

Introduction and Objectives

Risk stratification and thromboprophylaxis prevent venous
thromboembolism (VTE) associated maternal deaths. Identifying
women who require postpartum pharmacological
thromboprophylaxis and administering the correct dose and duration
of low molecular weight heparin (LMWH) is crucial in preventing
postpartum VTE. The RCOG guideline stratifies women at risk for
thromboembolism based on pre-existing, transient and obstetric risk
factors and recommends thromboprophylaxis based on risk scores.
This audit evaluated compliance with the RCOG guideline on
postpartum risk stratification and thromboprophylaxis in a tertiary
hospital in Sri Lanka.

Methods

Data were collected retrospectively from the hospital records of all
postnatal women on VTE risk assessment, dose and duration of
thromboprophylaxis for three consecutive months. A VTE prophylaxis
sticker was then designed and introduced to all postpartum women,
followed by a prospective re-audit over two months. Risk stratification
and thromboprophylaxis were evaluated as per the RCOG guideline

Results

The initial retrospective audit included 90 postnatal women, and the prospective re-audit following
the introduction of the VTE sticker included 60 women. In the initial audit, 37, 24, 18 and 16 women
scored 0, 1, 2, and ≥ 3, respectively; however, none had their risk scores documented in the hospital
records. 5.4% (2/37) with a score of 0, and 100% (24/24) with a score of 1 received LMWH,
although not indicated. 72.2% (13/18) scoring 2 received LMWH, albeit only for two days, while
68.7% (11/16) women with a score of ≥3 received LMWH, with only nine women receiving LMWH
for the recommended six weeks duration. Following the re-audit, 14, 17, 16 and 13 women scored 0,
1, 2 and ≥3, respectively, with 100% documentation of risk scores. Among those with a score of 0
and 1, 100% complied with the RCOG guideline and did not receive pharmacological
thromboprophylaxis. For women with a score of 2, 87.5% (14/16) received LMWH, albeit only for
two days, and 100% of those with a score of ≥3 received LMWH for six weeks complying with the
guideline

Conclusion

A decrease in unnecessary pharmacological thromboprophylaxis among postpartum women at low
risk for VTE and an increase in the percentage of women with scores of ≥2 receiving
pharmacological thromboprophylaxis was observed following the introduction of the VTE sticker.
Financial constraints accounted for women discontinuing thromboprophylaxis. The VTE sticker
helped maintain acceptable levels of clinical accuracy in risk stratification and targeted
pharmacological thromboprophylaxis per the RCOG guideline

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