Risk Stratification and Safety Profile of Pharmacological Prophylaxis for Venous Thromboembolism in Postpartum Women Following Cesarean Section: A Comparative Evaluation

ObjectiveVenous thromboembolism (VTE) remains a leading cause of maternal morbidity and mortality worldwide. This study evaluated VTE risk stratification among postpartum women following cesarean section, compared the 2023 National Guidelines (NG) with the Caprini score, and assessed pharmacological thromboprophylaxis safety.MethodsA single-center prospective cohort study was conducted on 386 women undergoing cesarean delivery at Nhan Dan Gia Dinh Hospital between February and July 2025. VTE risk was independently assessed using the 2023 NG and Caprini score. Demographic characteristics, operative variables, and short-term inpatient outcomes related to low-molecular-weight heparin (LMWH) or unfractionated heparin prophylaxis were analyzed.ResultsAccording to the 2023 NG, 71.0% of patients were classified as low risk, 15.5% as intermediate risk, and 13.5% as high risk. Major risk factors included emergency cesarean delivery (45.3%), maternal age above 35 years (23.1%), and obesity (20.5%). Using the Caprini score, 45.3% met criteria for pharmacological prophylaxis, representing a 56.2% increase compared with the 2023 NG. Among 110 women receiving thromboprophylaxis, LMWH accounted for 99.1% of treatment. No severe hemorrhagic complications or thrombocytopenia were observed. Adverse events were mild and localized, mainly injection-site ecchymosis.ConclusionThe 2023 NG generated fewer pharmacological prophylaxis indications than the Caprini score in this cohort. LMWH prophylaxis showed favorable short-term inpatient safety after cesarean delivery. Because follow-up was limited to hospitalization and the study was not powered for rare VTE events, these findings should be interpreted as allocation patterns and short-term safety rather than comparative effectiveness.