Venous Thromboembolism Prevention in Placenta Accreta Spectrum: Evaluation of a Novel Anticoagulation Bundle [ID 910]

INTRODUCTION: Placenta accreta spectrum (PAS) is characterized by abnormal placental attachment and hemorrhage at delivery. High-grade PAS necessitates a scheduled cesarean hysterectomy, subjecting patients to additional risk of venous thromboembolism (VTE) beyond the preexisting elevated risk in pregnancy (0.12%). We evaluate compliance and outcomes of a VTE bundle in patients undergoing scheduled cesarean hysterectomy for PAS. METHODS: A retrospective cohort study was conducted on scheduled cesarean hysterectomies completed for PAS at an academic PAS referral center from 2014 to 2024. Patients with active malignancy were excluded. Venous thromboembolism bundle included intraoperative administration of subcutaneous heparin, anticoagulation restarted within 8 hours postoperatively and continued through discharge, and prophylactic anticoagulation prescribed at discharge. Primary outcome was VTE within 6 weeks of delivery. Secondary outcomes of wound dehiscence, emergency department visits, reoperation, and readmission within 6 weeks of surgery were analyzed using SAS software. RESULTS: Of 90 patients, 20 (22.2%) received the complete bundle. Of those remaining, 28.5% had delayed postoperative anticoagulation but received all components. 71.4% were missing at least one component. Two patients (2.2%) had postpartum VTE, with no difference in rate of VTE ( P =.34) or secondary outcomes associated with receipt of the complete bundle. CONCLUSIONS/IMPLICATIONS: Venous thromboembolism incidence was 2.2% in this cohort, 18-fold higher than in otherwise pregnant individuals. There was no difference in VTE incidence between patients who received VTE bundle and those who did not. There was low administration of complete VTE bundle. Future work is needed to evaluate barriers to compliance and target quality improvement efforts.