Grille Sofía, Vitureira Gerardo, Morán Rosario, Retamosa Lucía, Alonso Valeria, Gómez Luis M, Quartara Federico, Feldman Florencia, López Valentina, Turcatti Paola, Castro Viviana, Sosa Leonardo, Guillermo Cecilia, Díaz Lilián, Stevenazzi Mariana
Cátedra de Hematología.
Clínica Ginecotológica B.
Blood Coagul Fibrinolysis. 2018 Apr;29(3):252-256. doi: 10.1097/MBC.0000000000000708.
: Venous thromboembolism remains as one of the leading causes of maternal death. Prevention of venous thromboembolism in the obstetric population is challenging as recommendations for prophylaxis have low grade of evidence. Risk factors and prophylaxis guidelines have been highlighted by Royal College of Obstetricians and Gynaecologists. In 2014, we developed a written alert following this guidelines to guide thromboprophylaxis. The aim of this study is to assess recommendations compliance. This study was conducted at University-Hospital in Uruguay from January 2014 to December 2016. A total of 1035 women were enrolled and stratified in high, intermediate or low risk based on Royal College of Obstetricians and Gynaecologists guidelines. Thromboprophylaxis was recommended for women at intermediate and high risk. Women were followed up to assess symptomatic thromboembolism or haemorrhagic complications. A total of 309 were pregnant and 731 puerperal. Median age was 24 (19-29) years old. Of them, 3.0% (n = 31) were at high risk and 35.4% (n = 366) at intermediate risk. All high-risk women received prophylaxis with low-molecular-weight heparin. Of the 366 intermediate-risk women, 52.7% received prophylaxis. Venous thromboembolism was developed in only one woman of the intermediate group, who had received prophylaxis. Bleeding complications were not observed. Awareness of the thrombotic risk, as conferred by an easy and suitable risk assessment, has the potential to improve venous thromboembolism prophylaxis in pregnant and puerperal women. We have a good guidelines compliance with the written alert in the high-risk women group. However, we have to improve low-molecular-weight heparin indication in intermediate-risk group, especially in postcaesarean women.
静脉血栓栓塞仍然是孕产妇死亡的主要原因之一。由于预防建议的证据等级较低，在产科人群中预防静脉血栓栓塞具有挑战性。皇家妇产科学院强调了风险因素和预防指南。2014年，我们根据该指南制定了一份书面警示，以指导血栓预防。本研究的目的是评估建议的依从性。本研究于2014年1月至2016年12月在乌拉圭的大学医院进行。根据皇家妇产科学院的指南，共纳入1035名女性，并将其分为高、中、低风险组。建议对中、高风险的女性进行血栓预防。对女性进行随访，以评估症状性血栓栓塞或出血并发症。共有309名孕妇和731名产妇。中位年龄为24（19-29）岁。其中，3.0%（n=31）为高风险，35.4%（n=366）为中风险。所有高风险女性均接受低分子量肝素预防。在366名中风险女性中，52.7%接受了预防。仅1名接受预防的中风险组女性发生了静脉血栓栓塞。未观察到出血并发症。通过简单且合适的风险评估提高对血栓形成风险的认识，有可能改善孕妇和产妇的静脉血栓栓塞预防。我们在高风险女性组中对书面警示的指南依从性良好。然而，我们必须改善中风险组中低分子量肝素的使用指征，尤其是剖宫产术后的女性。
