Post-Cesarean Thromboprophylaxis Checklist

How the checklist works

Every woman having a cesarean receives pneumatic sequential compression devices, placed before surgery starts and continued until she is fully ambulatory. LMWH is added only for a personal history of DVT or PE, or an inherited or acquired thrombophilia, and is continued for 6 weeks after surgery. The dose rises to intermediate when BMI is 40 kg/m² or more alongside either risk factor, and is individualized when risk factors combine. The interval before the first dose depends on the type of anesthesia and the dose level. In Consult Series #51, these recommendations are graded weak, based on low-quality evidence; the universal compression device recommendation is graded strong.

Notes on the source document

1. The checklist does not define "combinations of the above risk factors". The tool treats prior VTE together with a thrombophilia as a combination. BMI 40 or more with one risk factor has its own row in the checklist, so the tool does not count it as a combination.
2. The checklist lists protein C and protein S deficiency as low-risk inherited thrombophilias. Every listed thrombophilia, high or low risk, leads to the same 6 weeks of prophylactic LMWH.
3. Severe obesity without prior VTE or thrombophilia receives compression devices only. Other risk factors such as infection, preeclampsia, postpartum hemorrhage or prolonged immobility are not part of the checklist.
4. Doses are fixed and given as examples ("eg, enoxaparin"). Apart from the adjusted dose of 1 mg/kg every 12 hours, the checklist does not scale dose to weight.
5. The 4-hour interval after catheter removal applies to epidural catheters. For a single-shot spinal, only the interval from needle placement applies.
6. Significant intraoperative bleeding is addressed as a timing and drug-choice question, not as an indication for prophylaxis.
7. MTHFR mutations are explicitly not considered thrombophilias.