Evaluation of Complications in Postpartum Women Receiving Therapeutic Anticoagulation.
Adult
Anticoagulants
/ adverse effects
Cesarean Section
/ adverse effects
Delivery, Obstetric
/ adverse effects
Female
Heparin
/ adverse effects
Heparin, Low-Molecular-Weight
/ adverse effects
Humans
Obstetric Labor Complications
/ chemically induced
Postpartum Hemorrhage
/ chemically induced
Pregnancy
Retrospective Studies
Risk Factors
Venous Thromboembolism
/ drug therapy
Wounds and Injuries
/ chemically induced
Young Adult
Journal
Obstetrics and gynecology
ISSN: 1873-233X
Titre abrégé: Obstet Gynecol
Pays: United States
ID NLM: 0401101
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
pubmed:
11
7
2020
medline:
24
11
2020
entrez:
11
7
2020
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 32649504
doi: 10.1097/AOG.0000000000003971
pii: 00006250-202008000-00026
doi:
Substances chimiques
Anticoagulants
0
Heparin, Low-Molecular-Weight
0
Heparin
9005-49-6
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
394-401Références
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