Racial and Ethnic Disparities in Eligibility for Postpartum Venous Thromboembolism Prophylaxis in the United States.

BACKGROUND: Postpartum venous thromboembolism (VTE) incidence differs by race and ethnicity in the United States. However, it is unclear whether eligibility criteria for postpartum VTE prophylaxis mirrors this disparity.

METHODS: We analyzed the National Inpatient Sample from October 2015 through December 2019, using diagnosis and procedure codes to identify postpartum individuals and their VTE risk factors. We compared proportion of delivery hospitalizations meeting eligibility for thromboprophylaxis stratified by race/ethnicity, according to American College of Gynecology and Obstetrics (ACOG), American College of Chest Physicians (ACCP), Royal College of Obstetricians and Gynecologists (RCOG) and American Society for Hematology (ASH) guidelines.

RESULTS: Among a national estimate of 14,967,861 delivery hospitalizations in the United States, the proportion of individuals eligible for thromboprophylaxis using the RCOG, ACCP, ACOG, and ASH guidelines were 32.9%, 8.0%, 0.2% and 0.2% respectively. Using the RCOG criteria, non-Hispanic Black individuals had the highest proportion of thromboprophylaxis eligibility (39.7%), whereas it was lowest among Hispanic individuals (30.8%). Racial disparities in thromboprophylaxis eligibility were driven by differences in clinical risk factors (38.8% non-Hispanic Black population vs. 30.5% Hispanic population) and Caesarean section rates (35.9% vs. 32.2%), rather than history of VTE (0.3% vs. 0.1%), inherited thrombophilia (0.2% vs. 0.2%) or sickle cell disease (0.4% vs. <0.1%).

CONCLUSION: Non-Hispanic Black individuals were most likely to qualify for postpartum thromboprophylaxis, attributable to clinical risk factors rather than inherited risk factors. An urgent need exists to better understand ethno-racial disparities in thromboprophylaxis use and to equitably address modifiable risk factors for postpartum VTE.