Department of Blood Transfusion, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620978809. doi: 10.1177/1076029620978809.
Cesarean section is an independent risk factor for Venous thromboembolism (VTE). Low molecular weight heparin (LMWH) is extensively used for VTE prophylaxis after cesarean section. In this study, the effects of LMWH on coagulation and fibrinolysis after cesarean section and its clinical value were explored by studying the changes in laboratory indicators.
Antepartum and postpartum peripheral blood of 44 pregnant women who underwent vaginal delivery and 44 pregnant women who underwent cesarean section treated per routine with LMWH thromboprophylaxis on the first day post-operatively were collected for the following tests: D-dimer; thrombotic markers such as thrombomodulin (TM), thrombin-antithrombin complex (TAT), α2-plasmin inhibitor-plasmin complex (PIC), and tissue plasminogen activator inhibitor complex (t-PAIC); thromboelastography.
Compared to the antepartum levels, PIC increased, TM, TAT, and t-PAIC decreased significantly in the parturients after a spontaneous vaginal delivery. Compared to the antepartum levels, parturients routinely treated with LMWH after cesarean section had higher PIC levels and lower D-dimer, TAT, and t-PAIC levels. Compared with parturients after vaginal delivery, parturients treated with LMWH after cesarean section had higher levels of TM, R, and MA, while there was no significant differences in the levels of D-dimer, TAT, PIC, t-PAIC, K, angle, LY30, and CI.
The coagulation and fibrinolytic systems in gravidas and parturients are in a high level of dynamic equilibrium. The levels of coagulation and fibrinolytic system activation were similar in parturients who were routinely treated with LMWH after cesarean section compared with parturients after a spontaneous vaginal delivery.
剖宫产是静脉血栓栓塞症（VTE）的独立危险因素。低分子肝素（LMWH）广泛用于剖宫产术后 VTE 的预防。本研究通过研究实验室指标的变化，探讨 LMWH 对剖宫产术后凝血和纤溶的影响及其临床价值。
收集 44 例行阴道分娩的孕妇和 44 例行剖宫产术并于术后第 1 天常规接受 LMWH 预防血栓形成的孕妇产前和产后外周血，进行以下检测：D-二聚体；血栓标志物如血栓调节蛋白（TM）、凝血酶-抗凝血酶复合物（TAT）、α2-纤溶酶抑制剂-纤溶酶复合物（PIC）和组织型纤溶酶原激活物抑制剂复合物（t-PAIC）；血栓弹力图。
与产前水平相比，阴道分娩后的产妇 PIC 显著升高，TM、TAT 和 t-PAIC 显著降低。与产前水平相比，剖宫产术后常规接受 LMWH 治疗的产妇 PIC 水平较高，D-二聚体、TAT 和 t-PAIC 水平较低。与阴道分娩产妇相比，剖宫产术后接受 LMWH 治疗的产妇 TM、R 和 MA 水平较高，而 D-二聚体、TAT、PIC、t-PAIC、K、角度、LY30 和 CI 水平无显著差异。
孕妇和产妇的凝血和纤溶系统处于高度动态平衡状态。剖宫产术后常规接受 LMWH 治疗的产妇与阴道分娩产妇的凝血和纤溶系统激活水平相似。
