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. 2019 Aug 16;19(1):199.
doi: 10.1186/s12872-019-1183-3.

Critical appraisal of international guidelines for the prevention and treatment of pregnancy-associated venous thromboembolism: a systematic review

Jie Zheng  1 , Qinchang Chen  2 , Jing Fu  1 , Yanling Lu  3 , Tianjun Han  1 , Ping He  4
Affiliations

Critical appraisal of international guidelines for the prevention and treatment of pregnancy-associated venous thromboembolism: a systematic review

Jie Zheng et al. BMC Cardiovasc Disord. .

Abstract

Background: Pregnancy-associated Venous thromboembolism (VTE) is one of the most common causes of maternal morbidity and mortality in developed countries. In this study, we aimed to systematically review and critical appraisal of guidelines to compare the recommendations in pregnancy-associated VTE.

Methods: Guidelines in English between January 1, 2009 and November 31, 2018 were searched using Medline via PubMed, as well as the guidelines' website. The guidelines containing the recommendations on pregnancy-associated VTE were included. Through the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument, three reviewers appraised the quality of the included guidelines. The recommendations were also summarized and compared to analyze the consistency.

Results: Fifteen guidelines from 13 organizations were included. Ten guidelines from nine organizations, namely, ACCP, ANZJOG, ASH, Australia, ESC, Korea, RCOG, SASTH, SOCC, were regarded as "strongly recommended for use in practice". Most of the included guidelines scored low in lower scores in domain 3 (Rigor of development) and domain 6 (Editorial independence). Recommendations on prevention are contained in ten guidelines while treatment are included in seven. The main conflicting recommendations were mainly at the anticoagulant choice for prevention on pregnant women and prevention after cesarean section. The duration of VTE treatment in pregnant women was also controversial.

Conclusions: In summary, the quality of pregnancy-associated VTE guidelines varied widely, especially in Rigor of development and Editorial independence. Recommendations were inconsistent both in prevention and treatment across guidelines. Increased efforts are required to provide high-quality evidence specific to the pregnancy population. Guideline developers should also pay more attention to methodological quality.

Keywords: Pregnancy; Prevention; Treatment; Venous thromboembolism.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the identification process for guidelines on prevention and treatment in pregnancy-associated VTE
Fig. 2
Fig. 2
Final Domain Scores. AGREE II scores are plotted for each guideline for comparison. The higher percentage meant the better quality in the domain and was mapped towards the outer perimeter (closer to 100%)
See this image and copyright information in PMC

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