The laboratory control of anticoagulant thromboprophylaxis during the early postpartum period after cesarean delivery

J Perinat Med. 2018 Apr 25;46(3):251-260. doi: 10.1515/jpm-2016-0333.

Abstract

Introduction: The incidence of venous thromboembolism (VTE) after cesarean section is up to 0.6%, and the widespread use of cesarean section draws attention to this group. The dosage and duration of low-molecular-weight heparin (LMWH) prophylaxis after delivery is estimated by anamnestic risk-scales; however, the predictive potency for an individual patient's risk can be low. Laboratory hemostasis assays are expected to solve this problem. The aim of this study was to estimate the potency of tests to reflect the coagulation state of patients receiving LMWH in the early postpartum period.

Materials and methods: We conducted an observational study on 97 women undergoing cesarean section. Standard coagulation tests (Fg, APTT, prothrombin, D-dimer), an anti-Xa assay, rotation thromboelastometry and thrombodynamics/thrombodynamics-4D were performed. Coagulation assay parameters were compared in groups formed in the presence or absence of LMWH to estimate the laboratory assays' sensitivity to anticoagulation.

Results: Coagulation assays revealed hypercoagulation after delivery and a tendency toward normalization of coagulation during early postpartum. The thromboprophylaxis results revealed a higher percentage of coagulation parameters within the normal range in the LMWH group.

Conclusion: This research is potentially beneficial for the application of thrombodynamics and thrombodynamics-4D in monitoring coagulation among patients with high VTE risk who receive thromboprophylaxis with heparin.

Keywords: Cesarean section; LMWH; coagulation; postpartum; pregnancy; spatial thrombin generation; thrombodynamics.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adult
  • Anticoagulants / therapeutic use
  • Blood Coagulation Tests / statistics & numerical data*
  • Cesarean Section / adverse effects*
  • Elective Surgical Procedures
  • Female
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Middle Aged
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Postpartum Period / blood*
  • Pregnancy
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control*
  • Young Adult

Substances

  • Anticoagulants
  • Heparin, Low-Molecular-Weight