Division of Internal Medicine, Hôpital de Lasalle, CIUSSS de l'Ouest-de-l'Île, the Division of Internal and Obstetric Medicine, Centre Hospitalier de l'Université de Montréal, the Centre de Recherche Université de Montréal, and the Division of Obstetric Medicine, CHU-Sainte-Justine, Université de Montréal, Montréal, and the Division of Nephrology and Obstetric Medicine, CIUSSS de l'Estrie-CHUS, the Division of Obstetric Medicine, CIUSSS de l'Estrie-CHUS, the Department of Obstetrics & Gynecology, CIUSSS de l'Estrie-CHUS, the Department of Medicine, CIUSSS de l'Estrie-CHUS, Research Professional, and the Division of Internal and Obstetric Medicine, CIUSSS de l'Estrie-CHUS, University of Sherbrooke, Sherbrooke, Québec, Canada.
Obstet Gynecol. 2020 Aug;136(2):394-401. doi: 10.1097/AOG.0000000000003971.
To evaluate complications associated with early postpartum therapeutic anticoagulation.
A multicenter retrospective cohort study was done to evaluate the association between therapeutic anticoagulation postpartum and major complications (hemorrhagic and wound complications). Secondary outcomes included minor complications, risk factors associated with total complications (including the time to therapeutic anticoagulation resumption after delivery) and recurrent thrombotic events within 6 weeks postpartum.
From 2003 to 2015, 232 consecutive women were treated with therapeutic anticoagulation within 96 hours postpartum; among those treated, 91 received unfractionated heparin, 138 received low-molecular-weight heparin, and three received other anticoagulants. The primary outcome, a composite of major hemorrhagic complications (requiring transfusion, hospitalization, volume resuscitation, transfer to intensive care unit, or surgery) and major wound complications, occurred in 7 of 83 (8.4%) for cesarean deliveries and 9 of 149 (6.0%) for vaginal deliveries (P=.490). Total complications (including major and minor hemorrhagic and wound complications) occurred in 13 of 83 (15.7%) for cesarean deliveries compared with 9 of 149 (6.0%) for vaginal deliveries (P=.016). When comparing cases associated with and without complications, the median delay before resuming anticoagulation was significantly shorter for both cesarean (12 vs 33 hours, P=.033) and vaginal deliveries (6 vs 19 hours, P=.006). For vaginal deliveries, 8 of 51 (15.7%) women had complications when anticoagulation was started before 9.25 hours postpartum, compared with 1 of 98 (1.0%) when started after 9.25 hours. For cesarean deliveries, 7 of 21 (33.3%) of women experienced complications compared with 6 of 62 (9.7%) if anticoagulation was started before or after 15.1 hours, respectively. Two (0.9%) episodes of venous thromboembolism occurred within 6 weeks postpartum.
Among postpartum women who received early therapeutic anticoagulation, major complications occurred in 8.4% for cesarean deliveries and 6.0% for vaginal deliveries. Complications were associated with earlier resumption of therapeutic anticoagulation, particularly before 9.25 hours for vaginal deliveries and before 15.1 hours for cesarean deliveries.
评估产后早期治疗性抗凝相关并发症。
进行了一项多中心回顾性队列研究，以评估产后治疗性抗凝与主要并发症（出血和伤口并发症）之间的关系。次要结局包括小并发症、与总并发症相关的危险因素（包括产后恢复治疗性抗凝的时间）以及产后 6 周内复发性血栓事件。
2003 年至 2015 年，232 例连续产妇在产后 96 小时内接受治疗性抗凝治疗；其中 91 例接受普通肝素，138 例接受低分子肝素，3 例接受其他抗凝剂。主要结局为剖宫产术中主要出血并发症（需要输血、住院、容量复苏、转入重症监护病房或手术）和主要伤口并发症的复合事件，在 83 例剖宫产术中发生 7 例（8.4%），在 149 例阴道分娩中发生 9 例（6.0%）（P=0.490）。剖宫产术中总并发症（包括主要和次要出血及伤口并发症）发生率为 13/83（15.7%），阴道分娩中总并发症发生率为 9/149（6.0%）（P=0.016）。在比较有并发症和无并发症的病例时，剖宫产和阴道分娩中抗凝恢复前的中位时间分别显著缩短（分别为 12 小时与 33 小时，P=0.033；6 小时与 19 小时，P=0.006）。阴道分娩中，在产后 9.25 小时前开始抗凝的 51 例产妇中，有 8 例（15.7%）发生并发症，而在产后 9.25 小时后开始抗凝的 98 例产妇中，有 1 例（1.0%）发生并发症。剖宫产中，在 15.1 小时前或后开始抗凝的 21 例产妇中，分别有 7 例（33.3%）和 6 例（9.7%）发生并发症。产后 6 周内发生 2 例（0.9%）静脉血栓栓塞事件。
在接受早期治疗性抗凝的产后妇女中，剖宫产术中主要并发症发生率为 8.4%，阴道分娩中为 6.0%。并发症与更早恢复治疗性抗凝有关，尤其是阴道分娩中在产后 9.25 小时之前，剖宫产中在产后 15.1 小时之前。
