Koltsova Ekaterina M, Balandina Anna N, Grischuk Konstantin I, Shpilyuk Margarita A, Seregina Elena A, Dashkevich Natalia M, Poletaev Alexander V, Pyregov Alexey V, Sukhih Gennady T, Serebriyskiy Ilya I, Ataullakhanov Fazly I
Department of Biophysics and Systems Biology, Dmitry Rogachev National Research and Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation.
Center for Theoretical Problems of Physicochemical Pharmacology RAS, Moscow, Russian Federation.
J Perinat Med. 2018 Apr 25;46(3):251-260. doi: 10.1515/jpm-2016-0333.
The incidence of venous thromboembolism (VTE) after cesarean section is up to 0.6%, and the widespread use of cesarean section draws attention to this group. The dosage and duration of low-molecular-weight heparin (LMWH) prophylaxis after delivery is estimated by anamnestic risk-scales; however, the predictive potency for an individual patient's risk can be low. Laboratory hemostasis assays are expected to solve this problem. The aim of this study was to estimate the potency of tests to reflect the coagulation state of patients receiving LMWH in the early postpartum period.
We conducted an observational study on 97 women undergoing cesarean section. Standard coagulation tests (Fg, APTT, prothrombin, D-dimer), an anti-Xa assay, rotation thromboelastometry and thrombodynamics/thrombodynamics-4D were performed. Coagulation assay parameters were compared in groups formed in the presence or absence of LMWH to estimate the laboratory assays' sensitivity to anticoagulation.
Coagulation assays revealed hypercoagulation after delivery and a tendency toward normalization of coagulation during early postpartum. The thromboprophylaxis results revealed a higher percentage of coagulation parameters within the normal range in the LMWH group.
This research is potentially beneficial for the application of thrombodynamics and thrombodynamics-4D in monitoring coagulation among patients with high VTE risk who receive thromboprophylaxis with heparin.
剖宫产术后静脉血栓栓塞症（VTE）的发生率高达0.6%，剖宫产的广泛应用使这一群体受到关注。产后低分子量肝素（LMWH）预防的剂量和持续时间通过既往风险量表进行估算；然而，对个体患者风险的预测效力可能较低。实验室止血检测有望解决这一问题。本研究的目的是评估检测在反映产后早期接受LMWH治疗患者凝血状态方面的效力。
我们对97例行剖宫产的女性进行了一项观察性研究。进行了标准凝血检测（纤维蛋白原、活化部分凝血活酶时间、凝血酶原、D - 二聚体）、抗Xa检测、旋转血栓弹力图检测以及血栓动力学/血栓动力学 - 4D检测。在有或无LMWH的分组中比较凝血检测参数，以评估实验室检测对抗凝的敏感性。
凝血检测显示产后存在高凝状态，且产后早期凝血有恢复正常的趋势。血栓预防结果显示，LMWH组凝血参数在正常范围内的百分比更高。
本研究对于血栓动力学和血栓动力学 - 4D在监测接受肝素血栓预防的高VTE风险患者凝血方面的应用可能具有益处。
