Short-Course Enoxaparin Prophylaxis Reduces DVT Risk After Cesarean Delivery: Study
China: A recent study published in Medicine highlights the clinical value of combining plasma D-dimer testing, color Doppler ultrasound, and short-course enoxaparin sodium prophylaxis to predict and prevent lower extremity deep vein thrombosis (DVT) in high-risk women undergoing cesarean delivery.
The research was conducted by Huiqiu Jian from the Department of Gynaecology and Obstetrics, North China Medical & Health Group, XingTai General Hospital, Hebei, China, along with colleagues.
Deep vein thrombosis remains a serious postpartum complication, particularly in women with multiple risk factors undergoing cesarean section. Physiological hypercoagulability during pregnancy, combined with surgical trauma and reduced mobility after delivery, substantially increases thrombotic risk. Early identification and timely prevention are therefore essential to improving maternal outcomes.
In this study, the investigators evaluated the effectiveness of enoxaparin sodium prophylaxis alongside laboratory and imaging-based screening tools. A total of 172 high-risk parturients scheduled for cesarean section were enrolled and randomly assigned to either an observation group or a control group. Both groups received routine preventive care, while the observation group additionally received enoxaparin sodium initiated within 24 hours after surgery and continued for five days. Plasma D-dimer levels were regularly monitored, and color Doppler ultrasound was used to assess lower limb venous blood flow.
The study led to the following notable findings:
- Use of enoxaparin sodium in addition to routine preventive care was associated with a significantly lower incidence of postoperative venous thrombosis compared with routine care alone.
- The reduction in deep vein thrombosis risk did not lead to an increase in postpartum bleeding, supporting the safety of short-course anticoagulant prophylaxis in high-risk cesarean patients.
- Treatment with enoxaparin resulted in significant improvements in coagulation and hemorheological markers, with reductions in D-dimer, fibrinogen, prothrombin time, activated partial thromboplastin time, platelet count, plasma viscosity, and whole blood viscosity compared with baseline and control values.
- The erythrocyte deformability index was significantly higher in women receiving enoxaparin sodium, indicating improved blood flow properties.
- Color Doppler ultrasound showed significant increases in blood flow velocities of the femoral deep vein, popliteal vein, and posterior tibial vein after treatment, with greater improvements observed in the enoxaparin group, suggesting enhanced venous circulation and lower thrombus risk.
The researchers also emphasized the screening value of combining plasma D-dimer measurement with targeted Doppler ultrasound. While ultrasound demonstrated higher predictive accuracy on its own, the integrated use of both modalities enhanced early detection of DVT risk, enabling timely intervention without excessive or unnecessary imaging.
Overall, the findings support broader adoption of a combined preventive approach in high-risk obstetric patients. Integrating short-course enoxaparin sodium with routine care, guided by D-dimer levels and Doppler ultrasound monitoring during the early postpartum period, may substantially reduce thrombotic complications after cesarean section while maintaining maternal safety.
Reference:
Jian, Huiqiu MMa; Cui, Xiaojuan MMa; Dou, Yunyi MMa; Wang, Xiaofei MMa; Yuan, Hong MMa; Zhou, Ling MMa; Lu, Xinming MMb,*; Cai, Jinsheng MMc. Adoption of plasma D-dimer testing, color Doppler ultrasound, and enoxaparin sodium in predicting and preventing lower extremity deep vein thrombosis in high-risk parturients undergoing cesarean section. Medicine 104(50):p e45827, December 12, 2025. | DOI: 10.1097/MD.0000000000045827
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