围产期继续使用低分子肝素与转换为普通肝素的比较。

Comparison of Continuation of Low-Molecular-Weight Heparin versus Switching to Unfractionated Heparin in the Peripartum.

机构信息

Division of Maternal-Fetal Medicine, Texas Tech University Health Sciences Center, Permian Basin, Odessa, Texas.

Division of Maternal Fetal Medicine, University of Illinois at Chicago, Chicago, Illinois.

出版信息

Am J Perinatol. 2020 Feb;37(3):304-312. doi: 10.1055/s-0039-1678667. Epub 2019 Feb 28.

DOI:10.1055/s-0039-1678667

PMID:30818404

Abstract

OBJECTIVE

This study aimed to determine whether switching from low-molecular-weight heparin (LMWH) to unfractionated heparin (UFH) or its continuation in the peripartum affected anesthesia choice or bleeding complications.

STUDY DESIGN

A retrospective cohort study of 189 anticoagulated pregnant women who delivered at the University of Illinois at Chicago Hospital and Health Science System from 2005 to 2016. Demography, anesthesia choice, and bleeding complications were compared between the two groups.

RESULTS

There were 138 (73%) women on LMWH versus 51 (27%) who switched from LMWH to UFH during the peripartum. The demographics were similar, 123 women were on prophylactic: 81 (66%) were on LMWH and 42 (34%) switched to UFH. Of the 66 women on therapeutic anticoagulation, 57 (86%) continued on LMWH, while 9 (14%) switched to UFH. No difference in neuraxial anesthesia type received: 42 (82.4%) versus 108 (79.7%) women (odds ratio: 1.20, 95% confidence interval [CI]: 0.52-2.73, = 0.837). Bleeding complications more than 1,000 mL, 6 versus 10% (relative risk [RR]: 0.58, 95% CI: 0.17-1.94, = 0.380) and relaparotomy due to hemoperitoneum, 2% in either group (RR: 0.9, 95% CI: 0.10-8.48, = 0.930) were similar in the two groups regardless of time of last injection.

CONCLUSION

Anesthesia type and rate of bleeding complications were similar between women on LMWH and UFH during the peripartum.

摘要

目的

本研究旨在确定围产期从低分子肝素（LMWH）转换为未分级肝素（UFH）或继续使用LMWH 是否会影响麻醉选择或出血并发症。

研究设计

这是一项回顾性队列研究，纳入了 2005 年至 2016 年在伊利诺伊大学芝加哥医院和健康科学系统分娩的 189 名抗凝孕妇。比较了两组患者的人口统计学资料、麻醉选择和出血并发症。

结果

有 138 名（73%）孕妇使用 LMWH，51 名（27%）孕妇在围产期从 LMWH 转换为 UFH。两组患者的人口统计学特征相似，123 名患者接受预防性抗凝治疗：81 名（66%）使用 LMWH，42 名（34%）转换为 UFH。66 名接受治疗性抗凝的患者中，57 名（86%）继续使用 LMWH，9 名（14%）转换为 UFH。接受的神经轴麻醉类型无差异：42 名（82.4%）与 108 名（79.7%）女性（比值比：1.20，95%置信区间[CI]：0.52-2.73， = 0.837）。出血量超过 1000ml 的出血并发症分别为 6 名和 10%（相对风险[RR]：0.58，95%CI：0.17-1.94， = 0.380）和因血腹需再次剖腹探查的患者分别为 2%（RR：0.9，95%CI：0.10-8.48， = 0.930），两组间无差异。