Scrub HAT with VTE Risk Assessment 

Z. Arowojolu¹, A. Basu¹, S.Sharma¹, K. Sandhu², O. Song², A. Day^2
1Imperial College London, London, United Kingdom. ²West Middlesex University Hospital, London, United Kingdom 

 

Objective

• To review current evidence, guidelines, and available tools for Venous Thromboembolism (VTE) risk assessment in women experiencing an early pregnancy complication who are undergoing surgical management of miscarriage or ectopic pregnancy. 
• Conduct an audit to review compliance with the agreed VTE risk assessment, scoring and thromboprophylaxis at a London-based teaching hospital. 

 

Methods

Following recent incidences within the trust of two HATs in early pregnancy, local safety measures were implemented. An audit was conducted after 2 weeks in October 2022, and after 3 months in January 2023. 

Retrospective data were collected from all patients who underwent surgical management of miscarriage (SMM) or ectopic pregnancy. 

 

The information collected included: 

a)      The VTE assessment tool used and VTE score

b)      The patient-specific and procedure-related VTE risk 

c)      The thromboprophylaxis prescribed 

 

Interventions

• Memo circulated with guidance on the following: 
  • All surgical procedures in pregnancy (including SMM and ectopic pregnancy) should be assigned a score of 3 on an antenatal VTE assessment form
  • A VTE score of ≥ 4 for these patients should be followed by 10 days of VTE prophylaxis with Low Molecular Weight Heparin 
• Assessed VTE score added to Early Pregnancy Unit clerking proforma 
• Assessed VTE score added to handover sheet 

 

Results

Assessment Forms

From Oct 2022 to Jan 2023: 

7.9% increase in the percentage of patients with a completed VTE risk assessment form 

2% decrease in percentage of patients with appropriate antenatal assessment (overall) 

19% decrease in the percentage of patients with an appropriate antenatal assessment (forms filled) 

 

Thromboprophylaxis

From Oct 2022 to Jan 2023: 

4.1% increase in percentage of patients not having 10 days thromboprophylaxis when indicated 

3.3% increase in percentage of patients prescribed thromboprophylaxis when not indicated 

7.4% decrease in percentage of patients with appropriate management 

 

Conclusion

• Early pregnancy VTE-related complications are prevalent, making it crucial to have clear guidance to prevent HAT in this cohort of patients. 
• Significant uncertainty regarding the VTE risk assessment tool following surgical management of miscarriage and ectopic pregnancy. 
• Local efforts alone were insufficient in significantly increasing the proportion of women having a pregnancy-specific VTE risk assessment or appropriate thromboprophylaxis. 
• An evidence-based VTE risk assessment form that accounts for both patient-related and procedure-related factors and standardizes prophylaxis in this patient population is urgently required.