A comparison of the safety of two different enoxaparin doses for thromboprophylaxis following cesarean section

Abstract

Enoxaparin, from the low molecular weight heparin group, is used as thromboprophylaxis in patients with risk factors following caesarean section. The aim of this study was to investigate the effect of enoxaparin doses on the formation of deep vein thrombosis (DVT), wound site infection (WSI), wound site hematoma (WSH) and hemogram results of patients on the 10th postoperative day. A retrospective examination was made of the files of patients who had undergone a caesarean section operation and been administered enoxaparin as postpartum thromboprophylaxis for 10 days postoperatively. Two groups were formed of 16 patients who received enoxaparin at dose of 60mg/day and 25 patients who received 40mg/day. The groups were compared in respect of age, weight, gravida, gestational week at the time of operation, the leukocyte (Wbc), hemoglobin (Hb), and platelet (Plt) values on postoperative days 1 and 10, and the development of DVT, WSI, and WSH on postoperative day 10. The development of WSI and WSH was determined to be significantly higher in the group that received 60mg/day enoxaparin than in the group that received 40mg/day (p=0.007, p=0.008). With the use of 60mg/day enoxaparin, no change was observed in the Wbc and Hb values on the postoperative 10th day compared to the 1st day (p=0.128, p=0.947), and a significant reduction was determined in Plt values (p=0.014). With an increase in the dose of enoxaparin used as thromboprophylaxis following caesarean section in patients with risk factors, there was seen to be an increase in the formation of WSI and WSH. Compared to a dose of 40mg/day, the use of 60mg/day enoxaparin reduced serum Wbc, did not change Hb, and increased Plt values. Dose adjustment should be made for the drug used as caesarean postoperative thromboprophylaxis in patients with indications, taking the side-effects of enoxaparin into consideration.

Keywords

• caesarean
• deep vein thrombosis
• enoxaparin
• hemogram
• wound site infection-hematoma

Sezaryen Sonrası Tromboprofilaksi için İki Farklı Enoksaparin Dozunun Güvenirliğinin Karşılaştırılması

Abstract

Amaç: Sezaryen sonrası tromboprofilaksi için risk faktörü taşıyan hastalarda düşük molekül ağırlıklı heparin grubundan olan enoksaparin kullanılmaktadır. Uygulanan enoksaparinin dozları hastaların postoperatif kilolarına göre verilmektedir. Amacımız; enoksaparin dozlarının hastaların postoperatif onuncu gününde derin ventrombozu (DVT), yara yeri enfeksiyonu (YYE), yara yeri hematomu(YYH) oluşumu ve hemogram sonuçları üzerine olan etkisini araştırmaktır. Yöntem: Sezaryen ameliyatı olup, postoperatif dönemde 10 gün boyunca enoksaparin ile postpartum tromboproflaksi uygulanan hastaların dosya verileri retrospektif olarak tarandı. Çalışmaya sezaryen ameliyatı sonrası postoperatif dönemde tromboproflaksi için enoksaparin dozu 60 mg/gün kullanılan 16 kadın hasta ile enoksaparin dozu 40 mg/gün kullanılan 25 kadın hasta dahil edildi. Gruplar; yaş, gravida, ağırlık, operasyondaki gebelik haftası, hastaların postoperatif 1. gündeki ve 10. gündeki lökosit (wbc), hemoglobin (hb), trombosit (plt) değerleri, ve ayrıca, postoperatif 10. gündeki YYE, YYH ve DVT gelişimleri açısından karşılaştırıldı. Bulgular: Hastaların 1 (%2.43)’inde DVT, 9 (%21.95)’unda YYE, 4 (%9.75)’ ünde YYH izlendi. Enoksaparin 40 mg/gün kullanılan hastalar ile enoksaparin 60 mg/gün kullanılan hastalar karşılaştırıldıklarında; postoperatif 10. gündeki YYE ve YYH oluşumlarının enoksaparin 60 mg/gün alan grupta daha fazla olduğu izlendi (p=0.007 ve p=0.008). Enoksaparin kullanımı ile postoperatif 1. güne göre postoperatif 10. gündeki wbc ve hb değerlerinin değişmediği (p=0.128, p=0.947), plt değerlerinin ise anlamlı derecede azaldığı saptandı (p=0.014). Sonuç: Sezaryen sonrası tromboprofilaksi için risk faktörü taşıyan hastalarda kullanılan enoksaparin dozunun artışı ile YYE ve YYH oluşumunun arttırdığı görülmüştür. Enoksaparinin 40 mg/gün dozuna göre 60 mg/gün dozunda kullanımı ile serum wbc düşmekte, hb değişmemekte ve plt artmaktadır. Enoksaparinin yan etkileri göz önünde bulundurularak endikasyonu olan hastalarda sezaryen postoperatif tromboproflaksi için ilaç doz ayarlaması iyi yapılmalıdır.

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