Antepartum and postpartum thromboprophylaxis: A survey of current practices in South Africa and comparison with recommendations

Abstract

Background: Thromboprophylaxis guidelines are critical for VTE prevention, yet the optimal implementation of risk-appropriate thromboprophylaxis during pregnancy and postpartum remains uncertain. Methods: An electronic survey was distributed to 120 medical practitioners at the University of the Witwatersrand to assess thromboprophylaxis practices in pregnancy and postpartum. Results: Seventy (58%) responses were received, and 64 (53%) complete responses were analysed. Most respondents practiced in the public sector (83%) and followed clinical guidelines, with 50% adhering to the RCOG guideline. Low molecular weight heparin was widely prescribed during both antepartum and postpartum periods (94%), primarily at a fixed dose (53%). Barriers included lack of mechanical prophylaxis (30%), perceived complications of thromboprophylaxis (28%), and cost (22%). Case-based assessments revealed significant variation in practices due to complex risk assessment scoring systems and disparate guideline recommendations. Conclusion: Despite adherence to guidelines, variation in thromboprophylaxis practices highlights the need for evidence-based consensus recommendations to enhance clinical guidance