Why the study?
Does the implementation of the 2009 RCOG guidelines for the prevention of thromboembolic disease in pregnancy result in a high proportion of women requiring LMWH and increased costs?
Observational (n=100)
No
Does the implementation of the 2009 RCOG guidelines for the prevention of thromboembolic disease in pregnancy result in a high proportion of women requiring LMWH and increased costs?
Implementation of the 2009 RCOG guidelines for TED prevention in pregnancy would classify 51% of women as requiring LMWH, increasing costs 17-fold based on prevalent low-risk factors.
Thromboembolic disease (TED) has, for many years, consistently been identified as one of the leading causes of direct maternal mortality. In November 2009, the RCOG published a guideline on the prevention of TED that has been rapidly adopted by hospital trusts in the UK. The aim of our study was to determine the number and profile of women in our population that would require treatment with low molecular weight heparin (LMWH) and the cost implications of such treatment if these guidelines were implemented. A retrospective review of the first 100 women who delivered at the Coombe Women & Infants University Hospital (CWIUH) in 2010 was conducted and risk stratification applied at the relevant time points. A total of 51% were deemed to be at intermediate or high risk of TED at some point during pregnancy. In 35 of the 51 women (70%), this risk was attributable to factors such as age>35 years, parity≥3, BMI>30 kg/m2 or cigarette smoking. In our obstetric population, the percentage of women with these risk factors was: 25.5%, 8.5%, 19% and 16.7%, respectively. Implementation of this guideline would increase the hospital annual expenditure on LMWH by a factor of 17. The strategy of attributing risk by accumulating factors that individually have a low risk of TED and are prevalent in the population needs to be re-visited. The cost of implementation of these guidelines is not inconsiderable in the absence of data to indicate that clinical outcome is improved with their implementation.
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Hayes‐Ryan et al. (2012) conducted an observational in Pregnancy (n=100). RCOG guidelines for prevention of thromboembolic disease was evaluated on Intermediate or high risk of TED requiring LMWH treatment. Applying RCOG guidelines classified 51% of pregnant women as intermediate or high risk for thromboembolic disease, potentially increasing hospital LMWH expenditure 17-fold.
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