Abstract
Objectives: The indications and the efficacy of enoxaparin-induced thromboprophylaxis after the cesarean section in Karacabey State Hospital were evaluated. Patients and methods: A total of 611 births were performed between 1 January 2018 and 31 December 2018 In Karacabey State Hospital. Three hundred and twenty-eight 54% pregnant women were delivered by cesarean section. Twenty-two 7% pregnant women who were delivered by cesarean section underwent enoxaparin and 10 days postpartum thromboprophylaxis. Patients were called for control on the 11th postoperative day. In their control, DVT was questioned in terms of pulmonary embolism, drug allergy, bleeding, injection site reaction. Results: The mean age of the patients was 29.68 ± 6.02 years. The most indication was repeated cesarean section 9 40.9% . The most common thromboprophylaxis indication was obesity 12 54.5% . Thirteen 59.1% patients were given enoxaparin 60 mg / day and 9 40.9% had enoxaparin 40 mg / day . None of the patients had DVT, pulmonary embolism or enoxaparin-related complications. Conclusion: In this study, it was found that the administration of low molecular weight heparin and thromboprophylaxis was effective and safe for pregnant women with high-medium risk for thromboembolism.
Keywords
Postpartum thromboprophylaxis cesarean section enoxaparin deep vein thrombosis pulmonary embolism
References
- Andersen BS, Steffensen FH, Sorensen HT, Nielsen GL, Olsen J. The cumulative incidence of venous thromboembolism during pregnancy and puerperium–an 11 year Danish population- based study of 63,300 pregnancies. Acta Obstet Gynecol Scand. 1998;77:170-3.
- Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ, 3rd. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med. 2005;143:697-706. [CrossRef]
- Jacobsen AF, Skjeldestad FE, Sandset PM. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium–a registerbased case-control study. Am J Obstet Gynecol. 2008;198:233 e1-7. [CrossRef]
- Liu S, Rouleau J, Joseph KS, et al. Epidemiology of pregnancyassociated venous thromboembolism: a population-based study in Canada. J Obstet Gynaecol Can. 2009;31:611-20. [CrossRef]
- Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJ. Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost. 2008;6:632-7. [CrossRef]
- 1990 DPT Projeksiyonu,1998Hastane Araştırması Projeksiyonu ,2005 UAÖÇ, 2008-2014 SB verileri
- Blondon M, Casini A, Hoppe KK, Boehlen F, Righini M, Smith NL. Risks of venous thromboembolism after cesarean sections: a meta- analysis. Chest 2016;150:572–96. [CrossRef]
- Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ III. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30- year population-based study. Ann Intern Med 2005;143: 697–706. [CrossRef]
- Sanisoğlu S, Uygur D, Keskinkılıç B, Engin-Üstün Y, Keskin HL, Karaahmetoğlu S, Özcan A, Esen M, Ongun V, Özkan S. Maternal mortality cases from pulmonary embolism: A nation-wide study in Turkey. J Obstet Gynaecol. 2017;37:151-6. [CrossRef]
- T.C Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu. Riskli Gebelikler Yönetim Rehberi. 2014, Ankara.
- Kotaska A. Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence-based lens. BJOG. 2018;125:1109- 16. [CrossRef]
- T.C Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu. Gebelikte venöz tromboembolizm yönetim rehberi. 2017, Ankara.
- ACOG Practice Bulletin No. 196: Thromboembolism in Pregnancy. Obstet Gynecol. 2018;132:e1-e17. [CrossRef]
- Royal College of Obstetricians and Gynaecologists Green-Top Guideline No. 37a: Reducing the Risk of Thrombosis and Embolism During Pregnancy and the Puerperium. London: RCOG, 2015.
- Sénat MV, Sentilhes L, Battut A, et al. Postpartum practice: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2016;202:1-8. [CrossRef]
- Lindqvist PG, Hellgren M. Obstetric thromboprophylaxis: the Swedish guidelines. Adv Hematol. 2011;2011:157483. [CrossRef]
- Landon MB, Hauth JC, Leveno K, et al. Maternal and perinatal outcomes associated with a trial ofnlabor after prior cesarean delivery. N Engl J Med 2004;351:2581–9. [CrossRef]
- Goto M, Yoshizato T, Tatsumura M, Takashima T, Ogawa M, Nakahara H, Satoh S, Sanui A, Eguchi F, Miyamoto S. Safety and efficacy of thromboprophylaxis using enoxaparin sodium after cesarean section: A multi-center study in Japan. Taiwan J Obstet Gynecol. 2015;54:248-52. [CrossRef]
- Sultan AA, West J, Tata LJ, et al. Risk of first venous thromboembolism in and around pregnancy: a population-based cohort study. Br J Haematol 2012;156:366–73. [CrossRef]
- Schulman S, Beyth RJ, Kearon C, Levine MN; American College of Chest Physicians. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133: 257S–98S. [CrossRef]
- Sagaram D, Siddiq Z, Eisenberger AB, et al. Heparin-Induced Thrombocytopenia during Obstetric Hospital Admissions. Am J Perinatol. 2018;35:898-903. [CrossRef]
- Rodger M. Pregnancy and venous thromboembolism: ‘TIPPS’ for risk stratification. Hematology Am. Soc. Hematol. Educ. Program 2014;2014:387–92. [CrossRef]
- Greer IA, Nelson-Piercy C. Low-molecular weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 2005;106:401–7. [CrossRef]
- Bauersachs RM, Dudenhausen J, Faridi A, et al. Risk stratification and heparinprophylaxis to prevent venous thromboembolism in pregnant women. Thromb Haemost 2007;98:1237–45. [CrossRef]
- Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367:1066–74. [CrossRef]
- Cantwell R, Clutton-Brock T, Cooper G, et al. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118(suppl 1):1–203. [CrossRef]
- Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-related mortality in the UnitedStates, 2006–2010. Obstet Gynecol 2015;125:5–12. [CrossRef]
Abstract
Amaç: Karacabey Devlet Hastanesi’nde sezaryen sonrası enoksaparin ile uygulanan tromboprofilaksinin endikasyonları ve etkinliği değerlendirildi. Hastalar ve yöntem: Karacabey Devlet Hastanesinde 1 Ocak 2018-31 Aralık 2018 tarihleri arasında toplam 611 doğum gerçekleştirildi. 328 %54 gebe sezaryen ile doğurtuldu. Sezaryen ile doğurtulan gebelerin 22 %7 ’sine enoksaparin ile 10 gün postpartum tromboflaksi uygulandı. Hastalar postoperatif 11.günde kontrole çağrıldı. Kontrollerinde DVT, pulmoner emboli, ilaç alerjisi, kanama, enjeksiyon yerinde reaksiyon açısından sorgulandı. Bulgular: Olguların yaş ortalaması 29,68 ± 6,02 yıl olarak hesaplandı. Sezaryen endikasyonları arasında en sık eski sezaryen 9 %40,9 bulunmaktaydı. Trombofilaksi endikasyonları arasında en sık obezite 12 %54,5 bulunmaktaydı. 13 %59,1 lohusaya enoksaparin 60 mg/gün, 9 %40,9 ’una ise enoksaparin 40 mg/gün dozunda trombofilaksi verildi. Olguların hiçbirinde DVT, pulmoner emboli veya enoksaparine bağlı komplikasyon görülmedi. Sonuç: Bu çalışmada tromboemboli açısından yüksek-orta riske sahip gebelere düşük molekül ağırlıklı heparin ile trombofilaksi verilmesi nin etkin ve güvenli olduğu bulundu.
References
- Andersen BS, Steffensen FH, Sorensen HT, Nielsen GL, Olsen J. The cumulative incidence of venous thromboembolism during pregnancy and puerperium–an 11 year Danish population- based study of 63,300 pregnancies. Acta Obstet Gynecol Scand. 1998;77:170-3.
- Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ, 3rd. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med. 2005;143:697-706. [CrossRef]
- Jacobsen AF, Skjeldestad FE, Sandset PM. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium–a registerbased case-control study. Am J Obstet Gynecol. 2008;198:233 e1-7. [CrossRef]
- Liu S, Rouleau J, Joseph KS, et al. Epidemiology of pregnancyassociated venous thromboembolism: a population-based study in Canada. J Obstet Gynaecol Can. 2009;31:611-20. [CrossRef]
- Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJ. Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost. 2008;6:632-7. [CrossRef]
- 1990 DPT Projeksiyonu,1998Hastane Araştırması Projeksiyonu ,2005 UAÖÇ, 2008-2014 SB verileri
- Blondon M, Casini A, Hoppe KK, Boehlen F, Righini M, Smith NL. Risks of venous thromboembolism after cesarean sections: a meta- analysis. Chest 2016;150:572–96. [CrossRef]
- Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ III. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30- year population-based study. Ann Intern Med 2005;143: 697–706. [CrossRef]
- Sanisoğlu S, Uygur D, Keskinkılıç B, Engin-Üstün Y, Keskin HL, Karaahmetoğlu S, Özcan A, Esen M, Ongun V, Özkan S. Maternal mortality cases from pulmonary embolism: A nation-wide study in Turkey. J Obstet Gynaecol. 2017;37:151-6. [CrossRef]
- T.C Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu. Riskli Gebelikler Yönetim Rehberi. 2014, Ankara.
- Kotaska A. Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence-based lens. BJOG. 2018;125:1109- 16. [CrossRef]
- T.C Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu. Gebelikte venöz tromboembolizm yönetim rehberi. 2017, Ankara.
- ACOG Practice Bulletin No. 196: Thromboembolism in Pregnancy. Obstet Gynecol. 2018;132:e1-e17. [CrossRef]
- Royal College of Obstetricians and Gynaecologists Green-Top Guideline No. 37a: Reducing the Risk of Thrombosis and Embolism During Pregnancy and the Puerperium. London: RCOG, 2015.
- Sénat MV, Sentilhes L, Battut A, et al. Postpartum practice: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2016;202:1-8. [CrossRef]
- Lindqvist PG, Hellgren M. Obstetric thromboprophylaxis: the Swedish guidelines. Adv Hematol. 2011;2011:157483. [CrossRef]
- Landon MB, Hauth JC, Leveno K, et al. Maternal and perinatal outcomes associated with a trial ofnlabor after prior cesarean delivery. N Engl J Med 2004;351:2581–9. [CrossRef]
- Goto M, Yoshizato T, Tatsumura M, Takashima T, Ogawa M, Nakahara H, Satoh S, Sanui A, Eguchi F, Miyamoto S. Safety and efficacy of thromboprophylaxis using enoxaparin sodium after cesarean section: A multi-center study in Japan. Taiwan J Obstet Gynecol. 2015;54:248-52. [CrossRef]
- Sultan AA, West J, Tata LJ, et al. Risk of first venous thromboembolism in and around pregnancy: a population-based cohort study. Br J Haematol 2012;156:366–73. [CrossRef]
- Schulman S, Beyth RJ, Kearon C, Levine MN; American College of Chest Physicians. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133: 257S–98S. [CrossRef]
- Sagaram D, Siddiq Z, Eisenberger AB, et al. Heparin-Induced Thrombocytopenia during Obstetric Hospital Admissions. Am J Perinatol. 2018;35:898-903. [CrossRef]
- Rodger M. Pregnancy and venous thromboembolism: ‘TIPPS’ for risk stratification. Hematology Am. Soc. Hematol. Educ. Program 2014;2014:387–92. [CrossRef]
- Greer IA, Nelson-Piercy C. Low-molecular weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 2005;106:401–7. [CrossRef]
- Bauersachs RM, Dudenhausen J, Faridi A, et al. Risk stratification and heparinprophylaxis to prevent venous thromboembolism in pregnant women. Thromb Haemost 2007;98:1237–45. [CrossRef]
- Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367:1066–74. [CrossRef]
- Cantwell R, Clutton-Brock T, Cooper G, et al. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118(suppl 1):1–203. [CrossRef]
- Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-related mortality in the UnitedStates, 2006–2010. Obstet Gynecol 2015;125:5–12. [CrossRef]
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 1, 2020 |
| Published in Issue | Year 2020Issue: 4 |