Akaishi Miho, Tarasawa Kunio, Hamada Hirotaka, Iwama Noriyuki, Tomita Hasumi, Akaishi Tetsuya, Fushimi Kiyohide, Fujimori Kenji, Yaegashi Nobuo, Saito Masatoshi
Department of Obstetrics and Gynecology, Tohoku University, Sendai, JPN.
Department of Health Administration and Policy, Tohoku University, Sendai, JPN.
Cureus. 2024 May 8;16(5):e59933. doi: 10.7759/cureus.59933. eCollection 2024 May.
Use of unfractionated heparin (UFH) during the peripartum period is considered to be a higher risk of critical obstetric bleeding compared to low-molecular-weight heparin (LMWH). However, the evidence for the safety of using LMWH during the peripartum period is currently lacking.
This study retrospectively investigated a nationwide medical database to clarify the safety of using LMWH during childbirth. The Japanese Nationwide Diagnosis Procedure Combination database was retrospectively reviewed, and data from women with childbirth between 2018 and 2022 were collected.
Among the overall 354,299 women with childbirth, 3,099 were with obstetric disseminated intravascular coagulation (DIC), 484 were with critical obstetric bleeding requiring massive red blood cell (RBC) transfusion ≥4,000 cc, and 38 were with maternal death. Among the overall women, each of the anticoagulants other than LMWH was associated with critical obstetrical bleeding with an adjusted odds ratio (aOR) greater than 1.0, while LMWH was not associated with critical obstetrical bleeding (aOR, 0.54 (95% confidence interval, 0.11-2.71)). This finding did not change in subgroup analyses among those with Cesarean section. Furthermore, UFH was associated with critical bleeding among the 3,099 women with obstetrical DIC (aOR, 3.91 (2.83-5.46)), while LMWH was not (aOR, 0.26 (0.03-1.37)).
The use of UFH was significantly associated with an increased critical obstetric hemorrhage requiring massive RBC transfusion or total hysterectomy. Meanwhile, the use of LMWH was not associated with increased critical obstetric bleeding. LMWH would be safer than UFH to be used for women during childbirth.
与低分子量肝素（LMWH）相比，围产期使用普通肝素（UFH）被认为发生严重产科出血的风险更高。然而，目前缺乏围产期使用LMWH安全性的证据。
本研究回顾性调查了一个全国性的医学数据库，以阐明分娩期间使用LMWH的安全性。对日本全国诊断程序组合数据库进行回顾性审查，并收集2018年至2022年期间分娩女性的数据。
在总共354,299名分娩女性中，3099名患有产科弥散性血管内凝血（DIC），484名患有需要大量输注红细胞（RBC）≥4000 cc的严重产科出血，38名产妇死亡。在所有女性中，除LMWH外的每种抗凝剂与严重产科出血相关，调整后的优势比（aOR）大于1.0，而LMWH与严重产科出血无关（aOR，0.54（95%置信区间，0.11 - 2.71））。这一发现在剖宫产亚组分析中没有改变。此外，在3099名患有产科DIC的女性中，UFH与严重出血相关（aOR，3.91（2.83 - 5.46）），而LMWH则不然（aOR，0.26（0.03 - 1.37））。
UFH的使用与需要大量输注RBC或全子宫切除术的严重产科出血增加显著相关。同时，LMWH的使用与严重产科出血增加无关。LMWH用于分娩期女性比UFH更安全。
