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

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

Author information

1
Department of Biophysics and Systems Biology, Dmitry Rogachev National Research and Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation.
2
Center for Theoretical Problems of Physicochemical Pharmacology RAS, Moscow, Russian Federation.
3
Department of Anesthesiology and Critical Care Medicine, Kulakov Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation.
4
Laboratory of Clinical Immunology, Kulakov Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation.
5
Hemacore Labs LLC, Moscow, Russian Federation.
6
Laboratory Medicine Federation, Moscow, Russian Federation.
7
Faculty of Physics, Lomonosov Moscow State University, Moscow, Russian Federation.
8
Faculty of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation.

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

PMID:
28599392
DOI:
10.1515/jpm-2016-0333
[Indexed for MEDLINE]

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