Newswise — GLENVIEW, IL, September 22, 2016 – Roughly one-third of all births in Europe and North America now occur via cesarean section (CS). Following any birth, women are at an increased risk for a venous thromboembolism (VTE), but it’s believed that CS leaves women more vulnerable to VTE, blood clots, than vaginal delivery (VD). A new study published in CHEST determined that there is a link between CS and an increased absolute risk of VTE, including pulmonary embolism and deep vein thrombosis. Investigators found that CS was associated with a higher rate of overall VTE risk, with emergency CS associated with the greatest risk.
This comprehensive analysis systematically reviewed 60 authoritative studies related to postpartum VTE outcomes. Investigators found that CS carries a fourfold greater VTE risk than VD. “We found that CS is an important independent risk factor for the development of VTE in the postpartum period and that approximately three VTE will occur for everything 1,000 CS performed, with greater risks for nonscheduled emergency CS,” said lead investigator Marc Blondon, MD, Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva Switzerland. These risks were largely independent of other factors like maternal age and body mass index.
Pregnant women become more susceptible to VTE due to a variety of factors, including venous stasis and trauma associated to delivery. Also, hemostatic changes drive increases in some coagulation factors, while decreasing bleeding inhibitors, but for some reason these changes seem to be worse for women who deliver via CS. “In the postpartum period specifically, women following CS exhibit greater activation of coagulation than women following VD, as reflected by greater D-dimer levels,” explained Dr. Blondon. D-dimer levels indicate that blood clots may be forming or breaking down in the body. “This outcome may be a result of the conditions leading to the CS or to the procedure itself, similar to the increased VTE risk following non-obstetric surgery. Furthermore, physical activity is reduced following CS compared with following VD, with delayed recovery of mobility occurring in the first two days following delivery.”
As with many non-obstetric surgical procedures, thromboprophylaxis, or preventive measures taken to try and stop VTE before it happens, is commonly employed to try and minimize risk; however, researchers found little evidence on the use of thromboprophylaxis after CS. “Thromboprophylaxis seems widely underutilized in the United States: it is prescribed in 25% of women following CS (mainly compression stockings with less than 3% given heparin prescriptions),” stated Dr. Blondon. “It is estimated that 75% of women following CS do not receive any prophylaxis in the postpartum period. This scenario may arise from a lack of recognition by care providers of the risk of VTE following CS.”
Investigators also recommended against compression ultrasound when CS patients without symptoms of VTE are discharged from the hospital because their research indicated that it was not useful in catching postpartum DVT.
This new study helps shed some light on VTE risks associated with CS. Practitioners should be aware of the risks and further research is needed to plot the best course of action and inform future guidelines concerning thromboprophylaxis.
“Preventing postpartum VTE following CS may lead to an important reduction of its associated morbidity and mortality from a public health perspective,” concluded Dr. Blondon. “In this setting, further observational studies and randomized trials are needed to better appreciate the risks of VTE in specific groups following CS and to define the efficacy and safety of thromboprophylaxis.”
# # #
NOTES FOR EDITORS“Risks of Venous Thromboembolism After Cesarean Sections: A Meta-Analysis,” by Marc Blondon, MD; Alessandro Casini, MD; Kara K. Hoppe, DO; Françoise Boehlen, MD; Marc Righini, MD; and Nicholas L. Smith, PhD, DOI: http://dx.doi.org/10.1016/j.chest.2016.05.021 published in CHEST, Volume 150, Issue 3 (September 2016), by Elsevier.
Full text of this article is available to credentialed journalists upon request; contact Andrea Rodriguez, American College of Chest Physicians at +1 312-833-7947 or [email protected]. Journalists wishing to interview the authors may contact Marc Blondon, MD, at [email protected].
ABOUT CHEST®CHEST, the official publication of the American College of Chest Physicians, features the best in peer-reviewed, cutting-edge original research in the multidisciplinary specialties of chest medicine: pulmonary, critical care, and sleep medicine; thoracic surgery; cardiorespiratory interactions; and related disciplines. Published since 1935, it is home to the highly regarded clinical practice guidelines and consensus statements. Readers find the latest research posted in the Online First section each week and access series that provide insight into relevant clinical areas, such as Recent Advances in Chest Medicine; Topics in Practice Management; Pulmonary, Critical Care, and Sleep Pearls; Ultrasound Corner; Chest Imaging and Pathology for Clinicians; and Contemporary Reviews. Point/Counterpoint Editorials and the CHEST Podcasts address controversial issues, fostering discussion among physicians. www.chestnet.org/Publications/CHEST-Publications/CHEST-Journal
ABOUT AMERICAN COLLEGE OF CHEST PHYSICIANS (CHEST)American College of Chest Physicians (CHEST), publisher of the journal CHEST, is the global leader in advancing best patient outcomes through innovative chest medicine education, clinical research, and team-based care. Its mission is to champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research. CHEST serves as an essential connection to clinical knowledge and resources for its 18,700 members from around the world who provide patient care in pulmonary, critical care, and sleep medicine. CHEST Enterprises, Inc, a wholly owned subsidiary of CHEST, provides innovative education for health-care professionals and industry partners to advance best patient outcomes. For more information, visit chestnet.org.
ABOUT ELSEVIERElsevier (www.elsevier.com) is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions – among them ScienceDirect (www.sciencedirect.com), Scopus (www.scopus.com), Elsevier Research Intelligence (www.elsevier.com/research-intelligence), and ClinicalKey (www.clinicalkey.com) – and publishes over 2,500 journals, including The Lancet (www.thelancet.com) and Cell (www.cell.com), and more than 35,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group (www.relx.com), a world-leading provider of information and analytics for professional and business customers across industries. www.elsevier.com
RSS