• Study reports abnormally high VTE and high bleed risk in critically ill COVID-19 patients and calls for more effective prevention strategies.
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VTE prophylaxis

Preventative care for obstetric related venous thromboembolism (VTE)

Pulmonary embolism (PE) is the leading cause of maternal death in the developed world1.

Patients are 5 times more likely to develop deep vein thrombosis (DVT) during pregnancy2. The UK incidence of VTE in pregnancy and the puerperium is 1–2 episodes per 1,000 patients3 and accounts for 10% of all maternal deaths in the United States4.

NICE and the Royal College of Obstetricians and Gynaecologists (RCOG) recommends the use of low molecular weight heparin (LMWH) and/or mechanical compression in high-risk patients during childbirth. In some circumstances however, these options of prophylaxis can be contraindicated.

There are certain situations when standard method of VTE prophylaxis cannot be administered due to high risk of bleeding or the impending need for delivery.

Examples of these situations include:

  • Post-partum haemorrhage (PPH)
  • Low platelets
  • Severe pre-eclampsia
  • Intrapartum

The NICE medical technologies guidance (MTG19) recommends offering combined VTE prophylaxis with mechanical and pharmacological prophylaxis for patients who are pregnant or who have given birth during the previous 6 weeks, or who are having surgery, including caesarean section5.

Associated geko™ benefit
A pilot observational study concluded that high-risk pregnant patients who were contraindicated to standard pharmacological or mechanical methods of prophylaxis could be offered the innovative geko™ device safely during labour6.

References

  1. Paila Devis, Grace Knuttinen, DVT in pregnancy: incidence and endovascular management, review article, cardiovascular diagnosis and therapy, 2017;7 (suppl 3): S309-S319.
  2. Mrik PE, Plante LA Venous Thromboembolic disease in pregnancy. N Engl J Med 2008; 359:2025.
  3. RCOG guidelines - https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf.
  4. Abe K, Kuklina EV, Hooper WC, Callaghan WM. Venous thromboembolism as a cause of severe maternal morbidity and mortality in the United States. Semin Perinatol. 2019;43(4):200-204. doi:10.1053/j.semperi.2019.03.004
  5. NICE MTG19 - nice.org.uk/guidance/mtg19.
  6. Data on file, Barnsley Hospital, 2019.

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