Department of Obstetrics and Gynecology, Erasmus University Medical Center, Dr. Molewaterplein 60, Rotterdam, the Netherlands.
Acta Obstet Gynecol Scand. 2012 May;91(5):560-5. doi: 10.1111/j.1600-0412.2012.01351.x. Epub 2012 Feb 22.
To evaluate the safety of different regimes of thromboprophylaxis with low molecular weight heparins (LMWHs) in women undergoing cesarean section.
Retrospective single-center cross-sectional study.
University Medical Center, The Netherlands.
All women that delivered by cesarean section in the Erasmus Medical Center, Rotterdam, between January 2004 and December 2007 received thromboprophylaxis. We included women who received thromboprophylaxis according to the routine administration schedule at that time.
Three different consecutive regimes of thromboprophylaxis were used. In the first period, women received dalteparin 5000IU pre- and postoperatively (group A), in the second period, nadroparin 5700IU was administered pre- and postoperatively (group B), and in the third period, nadroparin 2850IU was administered not earlier than 6-12 hours postoperatively (group C). Detailed information on individual characteristics, cesarean section and postpartum period were extracted from patient files.
Postoperative bleeding complications.
A total of 1527 women were eligible and included. In group B, significantly more women experienced bleeding complications (necessitating either conservative treatment or re-laparotomy) compared with the other two groups (19/574 women in group B vs. 9/647 in group A and 1/306 in group C). After adjusting for potential confounders (maternal age, body mass index, and occurrence of preeclampsia/hemolysis, elevated liver enzymes and low platelet count) these effects remained significant (p=0.005). The incidence of thromboembolism was not different in the three groups.
Different regimes of thromboprophylaxis in women with cesarean section influenced the occurrence of bleeding complications.
评估不同低分子肝素（LMWH）预防剖宫产妇女血栓形成方案的安全性。
回顾性单中心横断面研究。
荷兰大学医学中心。
2004 年 1 月至 2007 年 12 月在鹿特丹伊拉斯谟医疗中心行剖宫产术的所有女性均接受了血栓预防治疗。我们纳入了当时按照常规管理方案接受血栓预防治疗的女性。
使用了三种不同的连续血栓预防方案。第一阶段，女性接受达肝素 5000IU 术前和术后（A 组）；第二阶段，给予那屈肝素 5700IU 术前和术后（B 组）；第三阶段，那屈肝素 2850IU 术后 6-12 小时后给予（C 组）。从患者档案中提取了个体特征、剖宫产术和产后阶段的详细信息。
术后出血并发症。
共有 1527 名女性符合条件并被纳入研究。B 组中，与其他两组相比，发生出血并发症（需要保守治疗或再次剖腹探查）的女性明显更多（B 组 574 名女性中有 19 例，A 组 647 名中有 9 例，C 组 306 名中有 1 例）。调整了可能的混杂因素（产妇年龄、体重指数、子痫前期/溶血、肝酶升高和血小板计数降低的发生）后，这些影响仍然显著（p=0.005）。三组间血栓栓塞的发生率无差异。
不同的剖宫产妇女血栓预防方案影响出血并发症的发生。
