依据日本旧标准和新标准对产科弥散性血管内凝血患者输注新鲜冰冻血浆、纤维蛋白原浓缩剂及抗凝血酶浓缩剂的情况

Fresh frozen plasma, fibrinogen concentrate, and antithrombin concentrate administration for obstetrical disseminated intravascular coagulation by the Japanese previous and new criteria.

作者信息

Morikawa Mamoru, Matsunaga Shigetaka, Makino Shintaro, Takeda Yoshiharu, Hyodo Hironobu, Nii Masafumi, Serizawa Mariko, Eto Eriko, Takeda Jun, Adachi Tomoko, Kobayashi Takao, Itakura Atsuo

机构信息

Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Osaka, Japan.

Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

出版信息

J Obstet Gynaecol Res. 2025 Feb;51(2):e16220. doi: 10.1111/jog.16220.

DOI:10.1111/jog.16220

PMID:39887536

Abstract

AIM

The purpose of this study is to clarify the frequencies of fresh frozen plasma (FFP) ± fibrinogen concentrate administration (fibrinogen concentrate [FC] therapy) and antithrombin (AT) concentrate administration (AT therapy) for the women with obstetrical disseminated intravascular coagulation (DIC).

METHODS

Two retrospective multicenter case-control studies as Study-1 (January-December 2018) and Study-2 (July 2022-June 2023) were conducted. Study-1 was the historical control of Study-2. All participants experienced a blood loss of ≥1000 mL during vaginal delivery or ≥2000 mL during cesarean section. All participants were subsequently assigned to the DIC group or non-DIC group.

RESULTS

Study-1 comprised 175 women (obstetrical DIC, 27; control, 148; by the previous criteria) and Study-2 comprised 175 women (obstetrical DIC, 9; control, 166; by the new criteria). The frequencies of FFP (±FC therapy) or FC therapy in DIC group were significantly higher than non-DIC group in Study-1 (88.9% vs. 25.0%, 44.4% vs. 4.0%) and Study-2 (100% vs. 24.7%, 77.8% vs. 5.4%); however, the frequencies of AT therapy were similar. Furthermore, in the DIC group, all women with fibrinogen <150 mg/dL received FFP ± FC therapy in Study-1 (n = 19) and Study-2 (n = 8); however, those with AT activity <70% received AT therapy (16.7% [4/24] and 12.5% [1/8], respectively).

CONCLUSION

We revealed an association between the high frequency of FFP ± FC therapy and lower fibrinogen levels, but a low frequency of AT therapy regardless of AT activity, in obstetrical DIC regardless of diagnosis criteria.

摘要

目的

本研究旨在明确产科弥散性血管内凝血（DIC）女性患者新鲜冰冻血浆（FFP）±纤维蛋白原浓缩剂给药（纤维蛋白原浓缩剂[FC]治疗）及抗凝血酶（AT）浓缩剂给药（AT治疗）的频率。

方法

开展了两项回顾性多中心病例对照研究，即研究1（2018年1月至12月）和研究2（2022年7月至2023年6月）。研究1为研究2的历史对照。所有参与者在阴道分娩期间失血≥1000 mL或剖宫产期间失血≥2000 mL。所有参与者随后被分为DIC组或非DIC组。

结果

研究1包括175名女性（产科DIC患者27名；对照组148名；按照先前标准），研究2包括175名女性（产科DIC患者9名；对照组166名；按照新标准）。在研究1（88.9%对25.0%，44.4%对4.0%）和研究2（100%对24.7%，77.8%对5.4%）中，DIC组FFP（±FC治疗）或FC治疗的频率显著高于非DIC组；然而，AT治疗的频率相似。此外，在DIC组中，研究1（n = 19）和研究2（n = 8）中所有纤维蛋白原<150 mg/dL的女性均接受了FFP±FC治疗；然而，AT活性<70%的女性接受了AT治疗（分别为16.7%[4/24]和12.5%[1/8]）。