Dr Simone Da Cruz1, Rita Wardan1, Charis Lau1, Shruti Bhushan1, Dr Briony Cutts1
1Department of Obstetric Medicine, Joan Kirner Women's and Children's Hospital at Sunshine Hospital, Western Health, St Albans, Australia
Biography:
Dr Simone Da Cruz is a General Medicine Advanced Trainee at Western Health.
Abstract:
Background: Superficial venous thrombosis (SVT) can be a painful symptomatic presentation commonly seen in pregnancy and post partum. The current treatment guidelines in non- pregnant patients do not take into account the hypercoagulable state of maternity patients.
Aim: To review the prevalence and management of SVT in maternity inpatients and determine concordance with current therapeutic guidelines for SVT.
Methods: After ethics approval, we undertook a retrospect audit of existing medical records from January 2019 to December 2023 inclusive to determine presentation of SVT and evaluate management in all maternity inpatients at Western Health. We identified how women birthed and venous thromboembolic risk factors present.
Pharmacy inpatient records were searched and included if coded with a diagnosis of ‘Phlebitis’, ‘thrombophlebitis’ and ‘venous thromboembolism’. Patients with SVT AND concurrent deep vein thrombosis were excluded. Deidentified data was captured and analysed on REDCAP.
Results: A total of n = 26 obstetric cases were identified: n = 9 were antenatal, and n = 17 were post-natal patients. A majority of patients (84.61%) received treatment with anticoagulation with the low molecular weight heparin (LMWH) enoxaparin. Treatment of anticoagulation ranged from thromboprophylactic to treatment doses (1.5mg/kg – 1mg/kg BD of enoxaparin). Antenatal and postnatal patients were identified as having 3 or more VTE risk factors in 66.7% and 52.9% respectively. The main risk factor for SVT in both antenatal and postnatal patients was varicose veins and 32.3% of postnatal patients experience significant post-partum haemorrhage > 1L. In the majority of patients, the therapeutic guideline for management of SVT was not followed.
Conclusion: This audit highlights a need to introduce a diagnostic and management algorithm for maternity patients with superficial venous thrombosis that takes into consideration specific pregnancy and birth associated VTE risk factors.
Keywords
Superficial venous thrombosis, Venous Thromboembolism, varicose veins, management