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首页> 外文期刊>The journal of maternal-fetal & neonatal medicine >Thromboprophylaxis following cesarean section - a nation-wide survey from Germany
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Thromboprophylaxis following cesarean section - a nation-wide survey from Germany

机译：剖宫产后凝血性血管薄膜 - 来自德国的全国范围内

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Objective: Our study aimed to assess current practice related to thromboprophylaxis following cesarean section (c.s.) among obstetricians in Germany taking account of the German and international guidelines. Study design: A nation-wide survey using a structured 22-item questionnaire was conducted in Germany. The questionnaire was sent to head of all registered departments of obstetrics and gynecology in Germany, followed by a single reminder followed 3 weeks after the first return deadline. The respondents' answers were related to the different levels of care (1-4) of German perinatal centers. Results: In total 726 obstetric departments were invited to participate. Questionnaires were returned by 389 (54%) of departments. Of the respondents 162 (41%) stated to undertake risk assessment for venous thromboembolism (VTE) using a structured checklist or interview. Compared to level 4 centers risk assessment was significantly more often performed by perinatal centers level 1 (47 versus 35%, p = .05). The majority of responding hospitals preferred universal heparin thromboprophylaxis following elective and emergency caesarean section, regardless of additional risk factors (n = 362; 93%). The "usual" prophylactic dose of heparin was given by the majority of hospitals (n = 280, 72%), while 98 (25%) hospitals used heparin doses adjusted to patients' body weight. In women at increased risk for VTE (e.g. previous VTE) there was a considerable variation in the recommended doses; 140 responding hospitals (36%) used 50-75% of the therapeutic heparin dose, 139 hospitals (36%) the "usual" prophylactic dose, and 97 hospitals (25%) preferred a therapeutic dose. In women at low risk for VTE 64% (n = 248) of hospitals recommended heparin thromboprophylaxis only during the hospital stay, 16% (n = 62) for at least 7 days after c.s., 4% (n = 15) for 10 days, 6% (n = 23) for 2-5 weeks, and 3% (n = 14) for 6 weeks postpartum. In women at increased risk level 1 centers prescribed heparin for VTE prophylaxis significantly more often for 6-8-week postpartum compared to level 4 centers (p = .02) whereas Level 4 centers used prophylactic heparin significantly more often <6 weeks (p = .01). Conclusion: Our survey reveals that the vast majority of hospitals (93%) used heparin prophylaxis after any c.s., irrespective of individual risk factors and the mode of c.s. (elective or emergency). This is in remarkable contrast to the recommendations from the German and other international guidelines. As well, we found a wide variation among respondents in dosing and duration of heparin related to the risk profile of VTE. This demonstrates, that there is little awareness and/or adherence to the German and other guideline recommendations which mirrors the inconsistencies between current guidelines. There is an urgent need to clarify optimal prophylaxis strategies after c.s. and the true magnitudes of benefits and harms associated with heparin prophylaxis by randomized controlled trials with sufficient statistical power.
机译：目的：我们的研究旨在评估德国妇产科妇后剖宫产分部（C.S.）后与血栓血管缺陷相关的实践考虑到德国和国际指南。研究设计：使用结构化22项问卷的全国范围内进行德国进行。调查问卷被派往德国妇产科的所有注册部门负责人，随后是一个提醒，在第一次回到截止日期后3周后。受访者的答案与德国围产期中心的不同护理水平（1-4）有关。结果：总共726项产科部门参加。问卷由389（54％）部门返回。受访者162（41％）使用结构清单或面试进行静脉血栓栓塞（VTE）的风险评估。与4级中心相比，风险评估更常见于围产期中心1（47对35％，P = .05）。大多数回应医院优选的通用肝素血浆丙基丙基脲后，伴有紧急剖腹产，无论额外的危险因素如何（n = 362; 93％）。 “常规”预防剂量的肝素被大多数医院给出（n = 280,72％），而98（25％）医院使用肝素剂量调节给患者体重。在妇女增加VTE的风险增加（例如，先前的VTE），推荐剂量有相当大的变化; 140响应医院（36％）使用50-75％的治疗性肝素剂量，139家医院（36％）“通常”预防剂量，97家医院（25％）优选治疗剂量。在VTE的较低风险的女性中，在医院的vte 64％（n = 248），只有在住院期间的肝素血栓血管糖尿布，在cs，4％（n = 15）后至少7天，10天（n = 62） 6％（n = 23）2-5周，产后6周，3％（n = 14）。在妇女上，风险增加1个中心，血统预防的肝素明显更常见于产后6-8周（P = .02），而4级4个中心使用预防性肝素常剧<6周（P = .01）。结论：我们的调查显示，绝大多数医院（93％）在任何C.S.之后使用了肝素预防，而不管个人风险因素和C.S.的模式。 （选修或紧急）。这与德国和其他国际指南的建议相比，这是显着的。同样，我们在与VTE的风险概况相关的肝素的剂量和持续时间内发现了广泛的变化。这表明，对德国和其他准则建议几乎没有意识和/或遵守，反映了当前指南之间的不一致。迫切需要在C.S.之后阐明最佳的预防策略。与具有足够统计功率的随机对照试验，与肝素预防相关的真正益处和危害。

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