Background: National guidelines have been developed to ensure correct dosing of tinzaparin for women delivered by caesarean delivery (CD) to reduce the risk of venous thromboembolism.
Aims: The aim of this study is to examine the impact of implementation of national guidelines on thromboprophylaxis prescribing practice for women undergoing CD in a university maternity hospital.
Methods: Details of tinzaparin usage were obtained from the Hospital pharmacy for the years 2009-2014. Information on CD and pulmonary embolism (PE) were obtained from the Hospital's annual clinical reports.
Results: Following guideline recommendations on weight-based tinzaparin for all women undergoing CD, the usage of syringes prefilled with tinzaparin 4500 IU increased from 526 to 8502 (P < 0.001) and usage of syringes prefilled with tinzaparin 10,000 IU increased from 36 to 910 (P < 0.001). Usage of syringes prefilled with tinzaparin 3500 IU decreased from 8216 in 2009 to 39 in 2014 (P < 0.001). During 2008-2010, there were two cases of PE after CD, both of whom received an inadequate dose of prophylactic tinzaparin. During 2011-2014 there were no cases of PE diagnosed after a total of 9427 CDs.
Conclusions: The development of national guidelines on thromboprophylaxis after CD was followed by a significant change in weight-based prescribing of tinzaparin. Following implementation, there have been no cases of PE after CD.
Keywords: Clinical guideline implementation; Low molecular weight heparin; Maternal medicine.