Duke University School of Medicine, Durham, North Carolina, USA.
Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Canada.
J Thromb Haemost. 2024 Feb;22(2):545-552. doi: 10.1016/j.jtha.2023.10.004. Epub 2023 Oct 13.
Postpartum venous thromboembolism (VTE) incidence differs by race and ethnicity in the United States. However, it is unclear whether the eligibility criteria for postpartum VTE prophylaxis mirror this disparity.
To characterize the prevalence of risk factors and eligibility for postpartum VTE prophylaxis, among US Birthing people, stratified by race and ethnicity.
We analyzed the National Inpatient Sample from October 2015 to December 2019, using diagnosis and procedure codes to identify postpartum individuals and their VTE risk factors. We compared proportion of delivery hospitalizations meeting eligibility for thromboprophylaxis stratified by race or ethnicity, according to American College of Gynecology and Obstetrics, American College of Chest Physicians, Royal College of Obstetricians and Gynecologists (RCOG), and American Society for Hematology guidelines.
Among a national estimate of 14 967 861 delivery hospitalizations in the United States, the proportion of individuals eligible for thromboprophylaxis using the RCOG, American College of Chest Physicians, American College of Gynecology and Obstetrics, and American Society for Hematology guidelines were 32.9%, 8.0%, 0.2%, and 0.2%, respectively. Using the RCOG criteria, non-Hispanic Black individuals had the highest proportion of thromboprophylaxis eligibility (39.7%), whereas it was lowest among Hispanic individuals (30.8%). Racial disparities in thromboprophylaxis eligibility were driven by differences in clinical risk factors (38.8% non-Hispanic Black population vs 30.5% Hispanic population) and cesarean section rates (35.9% vs 32.2%), rather than history of VTE (0.3% vs 0.1%), inherited thrombophilia (0.2% vs 0.2%), or sickle cell disease (0.4% vs <0.1%).
Non-Hispanic Black individuals were most likely to qualify for postpartum thromboprophylaxis, attributable to clinical risk factors rather than inherited risk factors. An urgent need exists to better understand ethno-racial disparities in thromboprophylaxis use and to equitably address modifiable risk factors for postpartum VTE.
在美国，产后静脉血栓栓塞症（VTE）的发病率因种族和民族而异。然而，产后 VTE 预防的资格标准是否反映了这种差异尚不清楚。
根据种族和民族，描述美国分娩人群中产后 VTE 预防的风险因素和资格的流行情况。
我们使用诊断和程序代码分析了 2015 年 10 月至 2019 年 12 月的全国住院患者样本，以确定产后个体及其 VTE 风险因素。我们比较了根据美国妇产科学院、美国胸科医师学会、皇家妇产科医师学院（RCOG）和美国血液学会指南，按种族或民族分层的符合血栓预防条件的分娩住院比例。
在美国全国估计的 14967861 例分娩住院中，符合 RCOG、美国胸科医师学会、美国妇产科学院和美国血液学会指南的血栓预防条件的个体比例分别为 32.9%、8.0%、0.2%和 0.2%。根据 RCOG 标准，非西班牙裔黑人的血栓预防资格比例最高（39.7%），而西班牙裔人的比例最低（30.8%）。血栓预防资格的种族差异是由临床风险因素（非西班牙裔黑人 38.8%，西班牙裔 30.5%）和剖宫产率（35.9% vs 32.2%）的差异驱动的，而不是 VTE 病史（0.3% vs 0.1%）、遗传性血栓形成倾向（0.2% vs 0.2%）或镰状细胞病（0.4% vs <0.1%）。
非西班牙裔黑人最有可能获得产后血栓预防资格，这归因于临床风险因素，而不是遗传风险因素。迫切需要更好地了解产后 VTE 预防中种族差异的原因，并公平地解决产后 VTE 的可改变风险因素。
