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Grand Rounds

What is the Risk for Venous Thromboembolism Following Cesarean Section?

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BACKGROUND AND PURPOSE:

  • Cesarean section is believed to be linked to greater risk for postpartum venous thromboembolism (VTE)
  • There is conflicting data, especially around the issue of emergency vs scheduled surgeries
  • Blondon et al. (CHEST Journal, 2016) sought to identify the risk of VTE and associated risk factors following cesarean section compared to vaginal delivery

METHODS:

  • Systematic review and meta-analysis
  • Systematic review of 28 mostly retrospective observational studies and 32 prospective studies reporting risks of VTE following cesarean section
  • Primary goal: Refine risk estimates of postpartum VTE following cesarean section, compared to vaginal delivery (both unadjusted and multiadjusted analyses)
  • Secondary goal: Provide meta-analytic summary estimate of incidence of postpartum VTE following cesarean section

RESULTS:

  • Mean age of women 25-30 years
    • BMI and thromboprophylaxis data often lacking
    • Majority of women were white but some studies were more diverse
  • Risk of VTE following cesarean section when analyzing individual studies ranged from 1 to 22 times that of vaginal delivery
    • Pooled OR 3.7 (95% CI, 3.0-4.6)
    • Pooled OR 5.9 (95% CI, 3.9-9.1) when only including studies with objective VTE diagnoses
  • Adjustment for age and BMI had a marginal influence on the estimated pooled OR
  • Estimates of associations were stronger for emergency CS, compared to elective CS even after adjustments
    • Elective section: OR 2.1 (95% CI, 1.5-2.9)
    • Emergency section: OR, 2.8 (95% CI, 2.1-3.6)
  • Based on prospective studies (32 studies; 120,603 women)
    • The pooled incidence was 2.6 VTE per 1,000 sections (95% CI, 1.7-3.5) and was greater in studies with a longer and better follow-up in the postpartum period (4.3 per 1,000 sections)
    • Mean age: 30 years
    • Mean BMI: 25 kg/m2

CONCLUSION:

  • VTE risk was approximately fourfold greater following cesarean section compared to vaginal delivery
  • Risk was greater following emergency vs elective section
  • Approximately 3 in 1,000 women will develop a VTE following cesarean section

Learn More – Primary Sources:

Risks of Venous Thromboembolism After Cesarean Sections: A Meta-Analysis

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How Common is Venous Thromboembolism During Neoadjuvant Treatment for Ovarian Cancer?
When to Stop Anticoagulation Following a DVT or Pulmonary Embolus?
Abnormal Vaginal Bleeding and Oral Anticoagulants for DVT – Results from the AMPLIFY trial
Can Genotype-Guided Dosing Decrease Warfarin Complications?

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