Sanofi South Africa.
S Afr Med J. 2019 Feb 26;109(3):186-192. doi: 10.7196/SAMJ.2019.v109i3.13487.
Venous thromboembolism (VTE) is associated with significant morbidity and mortality. Pregnancy and the puerperium are hypercoagulable states and increase the risk of VTE. There is a paucity of South African (SA) data related to use of thromboprophylaxis during pregnancy and the puerperium.
To evaluate local practice of VTE risk stratification among SA pregnant women and senior doctors' attitudes to VTE prophylaxis.
This was a cross-sectional descriptive study of conveniently sampled sites in the private and public health sectors. Patients with confirmed pregnancy and an underlying medical condition were enrolled after giving informed consent. Assessments were made based on the participating doctors' questionnaires and case report forms. In essence, this was a local evaluation of a specific group of patients by a specific group of doctors.
Two hundred and twenty patients were enrolled at six sites. In the participating doctors' opinion, 126/220 women assessed (57.2%) were at risk of VTE during pregnancy and the postpartum period (information was missing for 1 woman during the postpartum period). Of the women at risk of VTE, 23/126 (18.3%) were at high risk, 59/126 (46.8%) at moderate risk and 44/126 (34.9%) at low risk. Of the women identified as at risk of VTE, 104/127 (81.9%) received some form of VTE prophylaxis; 94/127 (74.0%) were at risk during pregnancy and 32/126 (25.4%) during the postpartum period. Of those who received pharmacological treatment, 15/15 received low-molecular-weight heparin during pregnancy and before delivery and 87/100 during the puerperium. Thirty-four patients received thromboprophylaxis for only 5 - 10 days after caesarean delivery, and 2 received mechanical thromboprophylaxis during pregnancy.
Doctors participating in the study were generally aware of VTE risk during pregnancy and the puerperium. Pharmacological thromboprophylaxis was the most commonly used intervention to reduce VTE risk. Mechanical thromboprophylaxis was underutilised. Adherence to VTE guidelines, specifically in terms of duration of thromboprophylaxis and its utilisation during pregnancy, was suboptimal.
静脉血栓栓塞症（VTE）与显著的发病率和死亡率相关。妊娠和产褥期是高凝状态，增加了 VTE 的风险。南非（SA）关于妊娠和产褥期使用血栓预防的数据很少。
评估南非孕妇的 VTE 风险分层的当地实践以及高级医生对 VTE 预防的态度。
这是一项在私营和公共卫生部门的便利抽样点进行的横断面描述性研究。在获得知情同意后，招募了确诊妊娠和潜在医疗状况的患者。评估是基于参与医生的问卷和病例报告表进行的。从本质上讲，这是一组特定的医生对一组特定患者的本地评估。
在六个地点共纳入 220 名患者。在参与医生看来，220 名评估的女性中有 126 名（57.2%）在妊娠和产后期间有 VTE 风险（1 名女性在产后期间的信息缺失）。在有 VTE 风险的女性中，23 名（18.3%）为高危，59 名（46.8%）为中危，44 名（34.9%）为低危。在确定有 VTE 风险的女性中，104 名（81.9%）接受了某种形式的 VTE 预防；94 名（74.0%）在妊娠期间，32 名（25.4%）在产后期间。在接受药物治疗的女性中，15 名（15%）在妊娠和分娩前接受低分子肝素治疗，100 名（80.0%）在产褥期接受治疗。34 名患者仅在剖宫产术后 5-10 天接受血栓预防治疗，2 名患者在妊娠期间接受机械血栓预防治疗。
参与研究的医生普遍意识到妊娠和产褥期的 VTE 风险。药物性血栓预防是降低 VTE 风险最常用的干预措施。机械性血栓预防的应用不足。VTE 指南的遵守情况，特别是在血栓预防的持续时间及其在妊娠期间的应用方面，并不理想。
