Selective enoxaparin protocol lowers hematoma rates without compromising VTE protection

A more selective risk-based approach to an enoxaparin thromboprophylaxis protocol appears to reduce the incidence of wound hematomas without increasing the rates of postpartum venous thromboembolism (VTE), as shown in a retrospective study.

Researchers looked at 17,489 patients who delivered at a single tertiary care centre and received standard risk-stratified vs more selective postpartum VTE chemoprophylaxis protocols. Those who had received outpatient anticoagulation for active VTE or had high VTE risk during pregnancy were excluded.

Of the patients, 12,430 (71 percent) were in the original protocol group and 5,029 (29 percent) were in the more selective group. Compared with the original protocol group, the more selective protocol group were older (28.5 years vs 27.7 years), had a higher BMI (31 vs 30 kg/m²), were more likely to use aspirin (23 percent vs 18 percent), and were more likely to have pre-eclampsia (21 percent vs 16 percent; p<0.001 for all). Chemoprophylaxis rates were halved, dropping from 16 percent (original protocol) to 8 percent (more selective protocol).

The primary outcome of wound hematoma up to 6 weeks postpartum occurred less frequently in the more selective vs original protocol group (0.3 percent vs 0.7 percent). The more selective protocol was associated with 62-percent lower odds of receiving a clinical diagnosis of wound hematoma postpartum (adjusted odds ratio [aOR], 0.38, 95 percent confidence interval [CI], 0.21–0.67)—a protective benefit driven by a lower rate of superficial wound hematomas (0.3 percent vs 0.6 percent; aOR, 0.43, 95 percent CI, 0.24–0.75).

There was no significant between-group difference in the incidence of VTE or individual types of VTE up to 6 weeks postpartum (0.1 percent vs 0.1 percent; aOR, 0.40, 95 percent CI, 0.12–1.36).