Impact of Prophylactic Low-molecular Weight Heparin Dosing on Clotting Parameters Following Cesarean Delivery
- Conditions
- Postpartum DVTThromboembolismThrombosis
- Interventions
- Registration Number
- NCT04305756
- Lead Sponsor
- University of Utah
- Brief Summary
The aim of this study is to evaluate the efficacy of two dosing regimens of low molecular weight heparin (LMWH) to reach prophylactic anti-factor Xa levels in post-cesarean delivery women. Half of participants will receive a fixed dose of LMWH, while the other half will receive a weight-based dose. The hypothesis is that the use of a weight-based dose will result in more women reaching prophylactic levels.
- Detailed Description
Venous thromboembolism (VTE) is a major contributor to maternal morbidity and mortality. The immediate postpartum period is a high risk time for VTE, and cesarean delivery is an additional risk factor. In the United States, use of postpartum VTE prophylaxis with low-molecular weight heparin (LMWH) is commonly used but without a standard protocol or dose across all hospitals. A fixed-dose of LMWH is frequently used based on data from non-obstetric studies. However, there are concerns that in the postpartum population this fixed dose may not be adequate for prophylaxis.
This study aims to evaluate the efficacy of fixed dose versus weight-based LMWH to reach prophylactic anti-Xa levels in post-cesarean delivery women. This will be a randomized controlled trial (RCT) with half of participants receiving a fixed dose of LMWH and half of participants receiving a weight-based dose of LMWH. The hypothesis is that the use of a weight-based LMWH compared to a fixed dose will result in more women achieving prophylactic anti-Xa levels.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 146
- Cesarean delivery
- Meet facility guidelines for postpartum venous thromboembolism (VTE) prophylaxis: Presence of 1 major, or 2 or more moderate, risk factors.
- Major risk factors: history of venous thromboembolism, high risk thrombophilia, BMI ≥40, high risk medical comorbidities (heart disease, sickle cell disease, systemic lupus erythematosus, inflammatory bowel disease), cesarean hysterectomy, nephrotic range proteinuria, or cesarean intrapartum/during labor
- Moderate risk factors: BMI > 30, multifetal pregnancy, postpartum hemorrhage (>1L blood loss), tobacco use, non-laboring or elective cesarean, preeclampsia, infection, preterm delivery (< 37 weeks gestational age), age > 35 years, low risk thrombophilia, family history of venous thromboembolism, stillbirth, varicose veins, prolonged labor (> 24 hours)
- Contraindication to anticoagulation
- Plan for therapeutic anticoagulation (antepartum or postpartum)
- Known renal dysfunction (Creatinine clearance < 30 mL/minute)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Weight-based LMWH Enoxaparin Participants will receive a weight-based dose of prophylactic enoxaparin. - For all BMI groups: 0.5mg/kg rounded to the nearest 10mg will be injected subcutaneously every 12 hours Fixed LMWH Enoxaparin Participants will receive a fixed dose of prophylactic enoxaparin. * For BMI \<40: 40mg injected subcutaneously every 24 hours * For BMI \> or = to 40: 40mg injected subcutaneously every 12 hours
- Primary Outcome Measures
Name Time Method Prophylactic peak anti-Xa level Postoperative day #3 at peak (4-6 hours post-dose) Anti-Xa level in prophylactic range (0.2 to 0.6 IU/mL)
- Secondary Outcome Measures
Name Time Method Wound Complications From delivery through 6 weeks postpartum Post-cesarean wound hematoma
Venous thromboembolism From delivery through 6 weeks postpartum Presence of venous thromboembolism as confirmed on diagnostic imaging
Trial Locations
- Locations (1)
University of Utah
🇺🇸Salt Lake City, Utah, United States