Low-molecular-weight heparin in pregnancy: peripartum bleeding complications
Low-molecular-weight heparin in pregnancy: peripartum bleeding complications
复制标题
DOI：
10.1038/sj.jp.7211745
复制
发表时间：
2007-06-01
影响因子：
2.9
通讯作者：
Hibbard, J. U.
中科院分区：
文献类型：
--
作者：
Kominiarek, M. A.;Angelopoulos, S. M.;Hibbard, J. U.
目的：比较低分子肝素（LMWH）治疗与未治疗的孕妇出血并发症。研究设计：对2001 - 2005年妊娠期间接受预防或治疗剂量低分子肝素的患者进行病例对照研究。低分子肝素的适应症包括当前或既往血栓栓塞、血栓形成或心脏瓣膜置换术。对照以2:1的比例选择病例，匹配递送路线，并选择为下两个连续递送。主要结局为产后出血（PPH）。比值比（ORs）以95%置信区间（ci）计算。结果：49名接受低分子肝素治疗的妇女分娩了55名婴儿。当前或既往血栓栓塞性疾病分别是15/55（27.3%）和26/55（47%）妊娠的抗凝指征。低分子肝素组肥胖孕妇较多（OR 3.91, CI 1.70 ~ 9.09），引产发生率较高(25/55 （45%)vs 29/110 (26%), P = 0.01）。估计失血量无差异(295.7+/-145.7 vs 308.6+/-111.9 cm，阴道P = 0.62；687.5+/-251.8 vs 765.0+/-313.2 cm(3)， P=0.34剖宫产),PPH （6/55, 11% vs 9/110, 8.2%; OR 1.37, CI 0.16 ~ 11.5）或输血（3/55,5.4% vs 4/110, 3.6%; OR 1.50, CI 0.3 ~ 7.48）。有2例产后肺栓塞，1例产妇死亡。结论：妊娠期接受低分子肝素治疗的患者出血并发症，包括PPH和输血，与分娩路径匹配的正常对照组相比没有增加。
Objective: To compare bleeding complications in pregnant patients treated with low-molecular-weight heparin (LMWH) to untreated controls.Study design: A case-control study of patients from 2001 to 2005 who received prophylactic or therapeutic doses of LMWH during pregnancy was carried out. Indications for LMWH included current or prior thromboembolism, thrombophilia, or heart valve replacement. Controls were chosen in a 2:1 ratio to cases, matched for delivery route, and selected as the next two consecutive deliveries. The primary outcome was postpartum hemorrhage (PPH). Odds ratios (ORs) were calculated with 95% confidence intervals (CIs).Results: Forty-nine women treated with LMWH delivered 55 infants. Current or prior thromboembolic disease was the anticoagulation indication in 15/55 (27.3%) and 26/55 (47%) of pregnancies, respectively. There were more obese gravidas (OR 3.91, CI 1.70 to 9.09) and labor induction was more common in the LMWH group, 25/55 (45%) vs 29/110 (26%), P = 0.01. There was no difference in estimated blood loss (295.7+/-145.7 vs 308.6+/-111.9 cm(3), P = 0.62 vaginal; 687.5+/-251.8 vs 765.0+/-313.2 cm(3), P=0.34 cesarean), PPH (6/55, 11% vs 9/110, 8.2%; OR 1.37, CI 0.16 to 11.5) or transfusion (3/55, 5.4% vs 4/110, 3.6%; OR 1.50, CI 0.3 to 7.48) between the cases and controls. There were two cases of postpartum pulmonary emboli, one with a maternal mortality.Conclusion: Bleeding complications, including PPH and transfusion, in patients treated with LMWH during pregnancy were not increased when compared to normal controls matched for delivery route.