Тромбоз, гемостаз и реология

Tromboz, Gemostaz I Reologiya
scientific and practical journal

ISSN 2078–1008 (Print); ISSN 2687-1483 (online)
2017, Original papers
2017

Changes of hemostatic parameters in prenatal and postnatal periods at woman with cesarean delivery: 616.15-07:616-71

Original papers
Published 2017-08-21
Маргарита Александровна Шпилюк
Research Center for Obstetrics, Gynecology and Perinatology named after academician V. I. Kulakov, Health Ministry of Russian Federation;
ФГБУ «Научный центр акушерства, гинекологии и перинатологии имени академика В. И. Кулакова» Министерства здравоохранения Российской Федерации;
Е. М. Кольцова
Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Health Ministry of Russian Federation;
ФГБУ «Национальный научно-практический центр детской гематологии, онкологии и иммунологии имени Дмитрия Рогачева» Министерства здравоохранения Российской Федерации;
А. Н. Баландина
Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Health Ministry of Russian Federation; Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences;
ФГБУ «Национальный научно-практический центр детской гематологии, онкологии и иммунологии имени Дмитрия Рогачева» Министерства здравоохранения Российской Федерации; ФГБУН «Центр теоретических проблем физико-химической фармакологии» Российской академии наук;
К. И. Грищук
Research Center for Obstetrics, Gynecology and Perinatology named after academician V. I. Kulakov, Health Ministry of Russian Federation;я
ФГБУ «Научный центр акушерства, гинекологии и перинатологии имени академика В. И. Кулакова» Министерства здравоохранения Российской Федерации;
О. С. Безнощенко
Research Center for Obstetrics, Gynecology and Perinatology named after academician V. I. Kulakov, Health Ministry of Russian Federation;
ФГБУ «Научный центр акушерства, гинекологии и перинатологии имени академика В. И. Кулакова» Министерства здравоохранения Российской Федерации;
И. И. Серебрийский
Association of Laboratory Specialists and Organizations «Federation of Laboratory Medicine»; Moscow, Russia
Ассоциация специалистов и организаций лабораторной службы «Федерация лабораторной медицины»; Москва, Россия
Алексей Викторович Пырегов
Research Center for Obstetrics, Gynecology and Perinatology named after academician V. I. Kulakov, Health Ministry of Russian Federation;
ФГБУ «Научный центр акушерства, гинекологии и перинатологии имени академика В. И. Кулакова» Министерства здравоохранения Российской Федерации;
Фазоил Иноятович Атауллаханов
Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Health Ministry of Russian Federation; Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences;
ФГБУ «Национальный научно-практический центр детской гематологии, онкологии и иммунологии имени Дмитрия Рогачева» Министерства здравоохранения Российской Федерации; ФГБУН «Центр теоретических проблем физико-химической фармакологии» Российской академии наук;
Татьяна Юрьевна Иванец
Research Center for Obstetrics, Gynecology and Perinatology named after academician V. I. Kulakov, Health Ministry of Russian Federation;
ФГБУ «Научный центр акушерства, гинекологии и перинатологии имени академика В. И. Кулакова» Министерства здравоохранения Российской Федерации;
Роман Георгиевич Шмаков
Research Center for Obstetrics, Gynecology and Perinatology named after academician V. I. Kulakov, Health Ministry of Russian Federation;
ФГБУ «Научный центр акушерства, гинекологии и перинатологии имени академика В. И. Кулакова» Министерства здравоохранения Российской Федерации;
Тромбоз, гемостаз и реология. — 2017. — №3(71)

Keywords

Сesarean section
venous thromboembolic complications
risk degree
hemostasis
  Full Text

Abstract

Introduction. To select a risk group of venous thromboembolic complications (VTE) is not a simple task. Today doctors use scales of risk scores that take into account only anamnestic data, and do not take into account hemostatic laboratory tests.

The aim of study: comparative assessment of plasma hemostatic parameters in prenatal and postnatal periods in women delivered by Cesarean section with high, medium and low VTE risks.

Materials and methods. We examined 235 pregnant women aged 21–45 years. Blood hemostatic parameters analyzed at 4 points: point 1 — before Cesarean section; point 2–3–5 hours after the end of operation; point 3–2 days after operation; point 4–4 days after operation. We measured fibrinogen and D-dimer levels, prothrombin (Quick’s value) and activated partial thromboplastin time. VTE risk assessed according to RCOG scale Green-top Guidelines №37a; degree of VTE risk development determined by the sum of scores.

Results. It was revealed that VTE risk at women in postnatal period obtained from the analysis of anamnestic data and hemostatic tests gave a different picture of patients’ state which can provide additional information about hemostasis of a particular patient.

Conclusion. D-dimer can be used as a marker of thrombotic readiness in women after Cesarean section, since all other analyzed parameters varied within reference ranges typical for postpartum.

References

  1. James A. H., Bushnell C. D., Jamison M. G. et al. Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol. 2005; 106 (3): 509–16.
  2. James A. H., Jamison M. G., Brancazio L. R. et al. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol. 2006; 194 (5): 1311–5.
  3. Heit J. A., Kobbervig C. E., James A. H. et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med. 2005; 143 (10): 697–706.
  4. Sidelnikova V. М. Habitual loss of pregnancy [Privychnaya poterya beremennosti]. Moskva: Triada-H. 2000: 304 s (in Russ.).
  5. Abdul Sultan A., Grainge M. J., West J. et al. Impact of risk factors on the timing of first postpartum venous thromboembolism: a population-based cohort study from England. Blood. 2014; 124 (18): 2872–80 (doi: 10.1182/blood-2014-05-572 834).
  6. Jacobsen A. F., Skjeldestad F. E., Sandset P. M. Ante- and postnatal risk factors of venous thrombosis: a hospital-based casecontrol study. J Thromb Haemost. 2008; 6 (6): 905–12 (doi: 10.1111/j.1538–7836.2008.02 961.x).
  7. Knight M. UKOSS. Antenatal pulmonary embolism: risk factors, management and outcomes. BJOG. 2008; 115 (4): 453– 61 (doi: 10.1111/j.1471–0528.2007.01 622.x).
  8. Guimicheva B., Czuprynska J., Arya R. The prevention of pregnancy-related venous thromboembolism. Br J Haematol. 2015; 168 (2): 163–74 (doi: 10.1111/bjh.13 159).
  9. Simpson E. L., Lawrenson R. A., Nightingale A. L. et al. Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. BJOG. 2001; 108 (1): 56–60.
  10. Larsen T. B., Sørensen H. T., Gislum M. Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study. Thromb Res. 2007; 120 (4): 505–9.
  11. Kovacevich G. J., Gaich S. A., Lavin J. P. The prevalence of thromboembolic events among women with extended bed rest prescribed as part of the treatment for premature labor or preterm premature rupture of membranes. Am J Obstet Gynecol. 2000; 182 (5): 1089–92.
  12. Macklon N. S., Greer I. A. Venous thromboembolic disease in obstetrics and gynaecology: the Scottish experience. Scott Med J. 1996; 41 (3): 83–6.
  13. Abbasi N., Balayla J., Laporta D. P. et al. Trends, risk factors and mortality among women with venous thromboembolism during labour and delivery: a population-based study of 8 million births. Arch Gynecol Obstet. 2014; 289 (2): 275–84 (doi: 10.1007/s00 404-013-2923-8).
  14. Chen L. B., Meng L. L., Chen H. et al. Coagulation and prothrombotic state parameters: Clinical analysis in early pregnancy. Zhonghua Yi Xue Za Zhi. 2013; 9 (27): 2146–8.
  15. Han L., Liu X., Li H. et al. Blood coagulation parameters andplatelet indices: Changes in normal and preeclamptic pregnancies and predictive values for preeclampsia. PLoS One. 2014; Vol. 9 (12): e114 488.
  16. Ivanets T. Yu., Vinogradova M. A., Dolgushina N. V. Reference intervals for hemostasis laboratory tests in the dynamics of physiological pregnancy [Referensnye intervaly dlya gemostaziologicheskih laboratornyh testov v dinamike fiziologicheskoj beremennosti]. Akusherstvo i ginekologiya. 2016; 9: 50–60 (in Russ.).
  17. Ho C. H. Can very high level of D-dimer exclusively predict the presence of thromboembolic diseases? J Chin Med Assoc. 2011; 74: 151–4.
  18. Damodaram M., Kaladindi M., Luckit J. et al. D-dimers as a screening test for venous thromboembolism in pregnancy: is it of any use? J Obstet Gynaecol. 2009; 29; 101–3.
  19. To M. S., Hunt B. J., Nelson-Piercy C. A negative D-dimer does not exclude venous thromboembolism (VTE) in pregnancy. J Obstet Gynaecol. 2008; 28: 222–3.
  20. Hiremath V. S., Gaffney G. Audit of thromboprophylaxis following caesarean section. Ir Med J. 2000; 93: 234–6.
  21. Palmerola K. L., D’Alton M. E., Brock C. O. et al. A comparison of recommendations for pharmacologic thromboembolism prophylaxis after caesarean delivery from three major guidelines. BJOG. 2016; 123 (13): 2157–62 (doi: 10.1111/1471– 0528.13 706).
  22. Prevention of venous thromboembolic complications in obstetrics and gynecology. Clinical recommendations (protocol) [Profilaktika venoznyh tromboembolicheskih oslozhnenij v akusherstve i ginekologii. Klinicheskie rekomendacii (protokol)]. Utv. MZ RF 27 maya 2014 goda № 15–4/10/2–3792. Moskva. 2014: 32 s (in Russ.).
  23. Hirota Y., Sakai M., Nakabayashi M. Changes in plasma coagulation markers with prophylactic treatment of low molecular weight heparin after cesarean section. Semin Thromb Hemost. 2005; 31 (3): 253–60.
  24. Cofrancesco E., Cortellaro M., Corradi A. et al. Coagulation activation markers in the prediction of venous thrombosis after elective hip surgery. Thromb Haemost. 1997; 77: 267–9.
  25. Vukovich T., Proidl S., Teufelsbauer H. et al. Laboratory monitoring of thromboprophylaxis with low molecular weight and standard heparin. Thromb Res. 1992; 66: 735–43