Implementation of the RCOG VTE Risk-Assessment Affects on Postpartum Prophylaxis Treatment in Women with SLE

There is no prospective, validated VTE risk-assessment tool for obstetric patients. The Royal College of Obstetrics & Gynecology (RCOG) proposed a VTE risk-assessment tool specific to this population. In March 2020, our institution transitioned to the RCOG VTE risk-assessment tool, utilizing a multi-pronged approach including department interdisciplinary education, and electronic medical record (EMR) clinical decision support tools. The RCOG VTE tool includes “active” Systemic Lupus Erythematosus (SLE) as a “very high-risk factor,” (3 points) and recommends discharge with pharmacologic VTE prophylaxis for a postpartum score ≥ 2. Our objective was to determine the impact of this multi-pronged implementation of the RCOG VTE risk-assessment tool on patients with SLE. This is a retrospective, quality improvement study to assess the impact of this intervention on women with SLE. We compare women with SLE who delivered at NYU Langone Health 3/1/2019-3/1/2020 (Pre-RCOG) to women who delivered 6/1/2020-6/1/2021 (Post-RCOG). The primary outcome was the rate of postpartum discharge recommendation of pharmacologic VTE prophylaxis in women with SLE Pre-RCOG v. Post-RCOG. Rheumatologists’ documentation was extracted from the EMR. There were 33 women with SLE Pre-RCOG and 34 women with SLE Post-RCOG. Demographics/VTE risk factors were similar between groups. (Table) Post-RCOG women with SLE were more likely to be prescribed postpartum pharmacologic VTE prophylaxis at discharge (88% v. 18%; p< 0.05). (Figure) The mean RCOG score amongst the Post-RCOG group was 4. While 16 of 34 Post-RCOG patients were given 3 points for “active SLE,” only 2 had documented active SLE by a rheumatologist. No patients had a documented postpartum VTE. At our health system, the multi-pronged approach to transitioning to the RCOG VTE risk-assessment tool increased the rate of postpartum pharmacologic VTE-prophylaxis in women with SLE. We also identified a need for an established definition of “active SLE” in the obstetric population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)