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

  • Ekaterina M. Koltsova , Anna N. Balandina EMAIL logo , Konstantin I. Grischuk , Margarita A. Shpilyuk , Elena A. Seregina , Natalia M. Dashkevich , Alexander V. Poletaev , Alexey V. Pyregov , Gennady T. Sukhih , Ilya I. Serebriyskiy and Fazly I. Ataullakhanov
Published/Copyright: May 25, 2017
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 46 Issue 3

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; coagulation; LMWH; postpartum; pregnancy; spatial thrombin generation; thrombodynamics

  1. Author’s statement

  2. Conflict of interest: Authors state no conflict of interest.

  3. Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.

  4. Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

  5. Funding: The study was supported by Russian Foundation for Basic Research and Moscow Government grant 15-34-70014 and by the Russian Federation President Grant for Young Scientists МК-913.2017.4. Thrombodynamics-4D analyzing was supported by grant from Russian Science Foundation (16-14-00-224) to FIA (Figures 1:F;2:M,N,O).

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Supplemental Material:

The online version of this article (DOI: https://doi.org/10.1515/jpm-2016-0333) offers supplementary material, available to authorized users.

Received: 2016-10-17
Accepted: 2017-4-19
Published Online: 2017-5-25
Published in Print: 2018-4-25

©2018 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Editorial
  4. Corner of Academy
  5. Peripartum cardiomyopathy – from pathogenesis to treatment
  6. Original articles – Obstetrics
  7. Is forty the new thirty? Population based study of advanced maternal age
  8. The laboratory control of anticoagulant thromboprophylaxis during the early postpartum period after cesarean delivery
  9. Epidural analgesia at trial of labor after cesarean (TOLAC): a significant adjunct to successful vaginal birth after cesarean (VBAC)
  10. Postpartum infection in relation to maternal characteristics, obstetric interventions and complications
  11. A technological advance for 21st century obstetricians: the electronically-controlled vacuum extractor
  12. Five years’ experience in an anesthesiology antenatal clinic for high-risk patients
  13. Clinical analyses of 383 cases with maternal cardiac diseases
  14. Induction of labor in patients with an unfavorable cervix after a cesarean using an osmotic dilator versus vaginal prostaglandin
  15. The misoprostol vaginal insert compared with oral misoprostol for labor induction in term pregnancies: a pair-matched case-control study
  16. Adiponectin concentration in mid-trimester amniotic fluid varies with the α-amylase level and maternal and neonatal outcomes
  17. Placental examination in nonmacerated stillbirth versus neonatal mortality
  18. Neurodevelopmental outcome at the age of 4 years according to the planned mode of delivery in term breech presentation: a nationwide, population-based record linkage study
  19. An observation of umbilical coiling index in a low risk population in Nigeria
https://doi.org/10.1515/jpm-2016-0333
Keywords for this article
Cesarean section; coagulation; LMWH; postpartum; pregnancy; spatial thrombin generation; thrombodynamics

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Editorial
  4. Corner of Academy
  5. Peripartum cardiomyopathy – from pathogenesis to treatment
  6. Original articles – Obstetrics
  7. Is forty the new thirty? Population based study of advanced maternal age
  8. The laboratory control of anticoagulant thromboprophylaxis during the early postpartum period after cesarean delivery
  9. Epidural analgesia at trial of labor after cesarean (TOLAC): a significant adjunct to successful vaginal birth after cesarean (VBAC)
  10. Postpartum infection in relation to maternal characteristics, obstetric interventions and complications
  11. A technological advance for 21st century obstetricians: the electronically-controlled vacuum extractor
  12. Five years’ experience in an anesthesiology antenatal clinic for high-risk patients
  13. Clinical analyses of 383 cases with maternal cardiac diseases
  14. Induction of labor in patients with an unfavorable cervix after a cesarean using an osmotic dilator versus vaginal prostaglandin
  15. The misoprostol vaginal insert compared with oral misoprostol for labor induction in term pregnancies: a pair-matched case-control study
  16. Adiponectin concentration in mid-trimester amniotic fluid varies with the α-amylase level and maternal and neonatal outcomes
  17. Placental examination in nonmacerated stillbirth versus neonatal mortality
  18. Neurodevelopmental outcome at the age of 4 years according to the planned mode of delivery in term breech presentation: a nationwide, population-based record linkage study
  19. An observation of umbilical coiling index in a low risk population in Nigeria
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