Patient and Clinician Perspectives on Postpartum Thromboembolism Risk and Pharmacologic Thromboprophylaxis Use: A Qualitative Study

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OBJECTIVE: Pregnancy-associated venous thromboembolism (VTE) risk is highest after delivery, and many hospitals recommend pharmacologic thromboprophylaxis during this period. There is a paucity of data on patient counselling received and clinician counselling provided on VTE risk and thromboprophylaxis. We aimed to determine information needs, perspectives and priorities regarding postpartum VTE risk communication and thromboprophylaxis education among people undergoing caesarean delivery and their obstetric clinicians. DESIGN: Qualitative study. SETTING: Single academic medical centre. POPULATION: Postpartum individuals after caesarean delivery and obstetric clinicians. METHODS: Semi-structured interviews were completed virtually by trained personnel with individuals within 12 weeks postpartum and obstetric clinicians to explore: (1) patient information needs on VTE risk communication; (2) perspectives on pharmacologic thromboprophylaxis; and (3) outcome priorities for decision-making around VTE and future research. Transcribed interviews were imported into a qualitative analytics software program. A standardized inductive coding framework was used in duplicate to identify themes. MAIN OUTCOME MEASURES: Qualitative data. RESULTS: Fifteen patients and 10 obstetric clinicians were interviewed. Patients were educated on the risk for VTE after caesarean delivery and rationale for thromboprophylaxis. Although patients reported discomfort (e.g., bruising, injection site pain) from prophylaxis administration, they reflected a willingness to use this therapy to reduce their risk of VTE and protect themselves. Patients identified some gaps in knowledge, opportunities for enhanced materials for education and willingness to participate in research. Clinicians endorsed providing counselling on VTE risk and thromboprophylaxis but identified barriers and recognized uncertainties on optimal management. Clinicians valued research that will improve evidence-based guidelines. CONCLUSIONS: While routine education on VTE risk and thromboprophylaxis is being provided, there are opportunities to improve communication. Patients and clinicians alike identified the necessity of research to inform precise individualized VTE risk estimates and the efficacy and risks of thromboprophylaxis.

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