One piece of evidence is missing, however, leaving an important question unanswered: In a low-risk population, is any form of DVT prophylaxis superior to standard postsurgical management that includes early ambulation? The “taxed” patient I described, who is at relatively low risk of clinically significant DVT, may warrant early ambulation and consideration of intermittent pneumatic compression or graded venous compression stockings.
By comparison to the NQF guideline, the American College of Chest Physicians (ACCP) recommends that you assess the risk of thrombosis in women undergoing cesarean delivery. ACCP does not recommend routine prophylaxis for women who are at low risk of DVT.5
ACOG has not offered an opinion on the routine use of DVT prophylaxis for low-risk women undergoing cesarean delivery.
What leads—good evidence, or common sense?
In a time of evidence-based medicine, promulgating clinical guidelines without relying on high-quality evidence is fraught with problems. When evidence is insufficient, or of poor quality, it’s best that guideline developers, including the NQF, do not resort to common-sense opinion to support their work.
Even when the evidence for a change in ObGyn practice is good, I believe that ACOG ought to lead in developing guidelines. The College is, after all, the national leader in advancing women’s health, and it has highly effective processes for evaluating the relative benefits and risks of new clinical recommendations that will have an impact on the care that we provide.
Editor’s note: Learn more about the National Quality Forum perinatal care uidelines and other NQF projects at http://www.qualityforum.org.