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VTE Prevention

Barnsley Hospital NHS Foundation Trust

Reducing VTE risk in obstetrics patients

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Following the positive results of our in-hospital, prospective observational study, the geko™ device is now in routine use on our maternity ward.

Working in partnership with Firstkind, we embraced the opportunity to examine the level of unmet need in our maternity patients when low molecular weight heparin (LMWH) and/or pneumatic mechanical compression (IPC) could not be used.

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, for example:

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

Our study5 focused on 90 patients over a period of 17 months and showed that all 90 patients required the geko™ device during some stage of labour, representing a 2% need overall.

More than half were prescribed the device as the only method of blood clot prevention. Of these:

  • 54% (49/90) postnatal patients needed the geko™ device as their only method of thrombo-prophylaxis
  • 94% (46/49), of the 54%, had postpartum haemorrhage (PPH)
  • 6% (3/49) had low platelets for which Daletparin was contra-indicated
  • 16% (15/90) with severe preeclampsia benefitted from the geko™ device antenatally during their admission as they were at risk of needing urgent delivery
  • 14% (13/90) had severe oedema or high BMI resulting in TED stockings being impractical to use.
  • 8% (7/90) were deemed high risk therefore the geko™ device was used to aid their mobility.
  • 2% (2/90) of patients who had antenatal Daletparin used the geko™ device during labour

Dr Fawzy and team – Barnsley Hospital NHS Foundation Trust

The study poster

Ultrasound video showing blood flow at baseline in the leg and with the geko™ device switched on.

Bionow Healthcare Project of the Year Award 2020

The geko™ device was used for a maximum of 36 hours. The study also reported the device as easy to fit, safe, and well tolerated and, compared to pneumatic IPC sleeves, it allowed patients to be more mobile, thereby reducing the VTE risk further.

Now in routine use, the geko™ device is prescribed when other pharmacological methods are contraindicated or impractical, ensuring that all our high-risk patients can receive pregnancy-related blood clot prevention where previously no mechanical prophylaxis could be prescribed.

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 section6.

References

  1. Devis et al. DVT in pregnancy: incidence and endovascular management, review article, cardiovascular diagnosis and therapy, 2017;7 (suppl 3): S309-S319.
  2. Mrik et al. 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 et al. 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. Fawzy, Andrzejowska, Godwin. Further update on the role of geko™ in reducing the risk of venous thromboembolism (VTE) in Obstetrics. Poster: https://www.gekodevices.com/wp-content/uploads/2020/08/Obstetrics-Poster-_DIGITAL-2.pdf
  6. NICE MTG19 - nice.org.uk/guidance/mtg19

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