Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China.
Department of Obstetrics & Gynecology, Changxing Maternal and Child Health Hospital, Huzhou, Zhejiang, China.
Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620901786. doi: 10.1177/1076029620901786.
The aim of this study was to investigate the d-dimer for prediction of venous thromboembolism (VTE) events in puerperium and to identify other risk factors associated with the occurrence of VTE. This was a prospective observational cohort study, which included 16 127 women who gave birth after 28 weeks of gestation at Women's Hospital of Zhejiang University, School of Medicine, from January 2016 to December 2016. Data including basic maternal and fetal characteristics, pregnancy complications, and predictive biomarkers within postpartum 24 hours including d-dimer, platelet, and fibrinogen were collected for analyses. In the cohort study, 19 (0.12%) women were identified as VTE, including 1 pulmonary embolism event and 18 deep venous thrombosis events. The receiver operating characteristic curve analysis suggested the best cutoff point for d-dimer level within postpartum 24 hours was 3.695 mg/L, with a specificity of 75.5% and a sensitivity of 73.7%, and there was no statistical correlation between fibrinogen and VTE, as well as between platelets and VTE. On multivariate analysis, age ≥35 years (odds ratio [OR] = 2.895, 95% confidence interval [CI]: 1.079-7.773), scarred uterus (OR = 3.894, 95% CI: 1.234-12.282), intrauterine infection (OR = 7.214, 95% CI: 1.519-34.262), antiphospholipid syndrome (OR = 199.530, 95% CI: 15.152-2627.529), d-dimer ≥3.70 mg/L (OR = 7.573, 95% CI: 2.699-21.247), and emergency cesarean delivery (OR = 23.357, 95% CI: 2.819-193.508) were independently associated with VTE in puerperium. We concluded that d-dimer ≥3.70 mg/L was an independent predictor of VTE during puerperium and d-dimer testing was necessary for perinatal women.
本研究旨在探讨 D-二聚体对产褥期静脉血栓栓塞症（VTE）事件的预测价值，并确定与 VTE 发生相关的其他危险因素。这是一项前瞻性观察性队列研究，纳入了 2016 年 1 月至 2016 年 12 月在浙江大学医学院附属妇产科医院分娩且孕周≥28 周的 16127 名产妇。收集了包括基本母婴特征、妊娠并发症和产后 24 小时内预测生物标志物（包括 D-二聚体、血小板和纤维蛋白原）在内的数据进行分析。在该队列研究中，19 名（0.12%）产妇被诊断为 VTE，包括 1 例肺栓塞和 18 例深静脉血栓形成。受试者工作特征曲线分析提示产后 24 小时内 D-二聚体水平的最佳截断值为 3.695mg/L，其特异性为 75.5%，敏感性为 73.7%，纤维蛋白原和 VTE 之间以及血小板和 VTE 之间均无统计学相关性。多因素分析显示，年龄≥35 岁（比值比 [OR] = 2.895，95%置信区间 [CI]：1.079-7.773）、瘢痕子宫（OR = 3.894，95% CI：1.234-12.282）、宫内感染（OR = 7.214，95% CI：1.519-34.262）、抗磷脂综合征（OR = 199.530，95% CI：15.152-2627.529）、D-二聚体≥3.70mg/L（OR = 7.573，95% CI：2.699-21.247）和急诊剖宫产（OR = 23.357，95% CI：2.819-193.508）与产褥期 VTE 独立相关。我们得出结论，D-二聚体≥3.70mg/L 是产褥期 VTE 的独立预测因素，D-二聚体检测对围产期妇女是必要的。
