Division of General Internal Medicine, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland.
Thromb Res. 2011 Feb;127 Suppl 3:S9-S12. doi: 10.1016/S0049-3848(11)70004-4.
Although venous thromboembolism (VTE) is the leading cause of maternal mortality in developed countries, the usefulness of preventive low-molecular weight heparin (LMWH) after cesarean section remains a matter of controversy. This article will review a recent decision analysis addressing this question, comparing a 7-day LMWH with none in this setting. Prophylaxis with LMWH yielded the highest quality-adjusted life expectancy, with a net gain of 1.5 days per treated patient. Sensitivity analyses showed the incidence of VTE after cesarean section and the haemorrhagic risk related to LMWH to be critical, at threshold values of 0.22% and 0.24% respectively. In the hypothetical cases created by the authors, LMWH was safe but only marginally more effective in women with no risk factors. With the addition of other risk factors, reductions in VTE greatly outnumbered the increase in major hemorrhages. This study highlights the need to assess the individual thrombotic risk in women after a cesarean section.
尽管静脉血栓栓塞症（VTE）是发达国家产妇死亡的主要原因，但剖宫产术后预防性使用低分子肝素（LMWH）的效果仍存在争议。本文将回顾一项针对该问题的最新决策分析，比较了剖宫产术后使用 7 天 LMWH 与不使用 LMWH 的情况。LMWH 预防可获得最高的质量调整生命预期，每位治疗患者的净收益为 1.5 天。敏感性分析显示，剖宫产术后 VTE 的发生率和与 LMWH 相关的出血风险至关重要，分别为 0.22%和 0.24%。在作者创建的假设病例中，LMWH 是安全的，但在无风险因素的女性中，其效果仅略有改善。随着其他危险因素的增加，VTE 的减少大大超过了大出血的增加。这项研究强调了在剖宫产术后需要评估女性的个体血栓形成风险。
