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

Yıl 2022, Cilt: 39 Sayı: 1, 62 - 65, 01.01.2022

Öz

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.

Kaynakça

  • 1. Thromboembolism in pregnancy. Practice Bulletin No. 123. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011; 118:718–729.
  • 2. T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu. Riskli Gebelikler Yönetim Rehberi. 2014, Ankara.
  • 3. Kotaska A. Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence-based lens. BJOG. 2018;125:1109-1116.
  • 4. Bıyık İ. Sezaryen Sonrası Tromboflaksisinin Uygulanan Olguların Değerlendirilmesi. ACU Sağlık Bil Derg 2020; 11(4):641-645.
  • 5. T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu. Gebelikte venöz tromboembolizm yönetim rehberi. 2017, Ankara.
  • 6. Royal College of Obstetricians and Gynaecologists Green-Top Guideline No. 37a: Reducing the Risk of Thrombosis and Embolism During Pregnancy and the Puerperium. London: RCOG, 2015.
  • 7. Sénat MV, Sentilhes L, Battut A. Postpartum practice: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J ObstetGynecolReprodBiol.2016;202:1-8.
  • 8. Lindqvist PG, Hellgren M. Obstetric thromboprophylaxis: the Swedish guidelines. AdvHematol. 2011;2011:157483.
  • 9. Nystrom PO, Jonstam A, Hojer G, Ling L. Incisional infection after colorectal surgery in obese patients. ActaChirScand 1987; 153: 225-227.
  • 10. Samama MM. Epidemiology of risk factors of deep venous thrombosis (DVT) of the lower limbs in community practice: the SIRIUS study. ThrombHaemost 1993;769:763.
  • 11. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd. Risk factors for deep vein thrombosis and pulmonary embolism: A population-basedcase-control study. ArchInternMed 2000;160(6):809–815.
  • 12. Alikhan R, Cohen AT, Combe S. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness: Analysis of the MEDENOX Study. ArchInternMed 2004;164(9):963–968.
  • 13. Shannon M. Bates. Treatment and prophylaxis of venous thromboembolism during pregnancy. ThrombosisResearch 2003;108:97–106.
  • 14. Kafkas S, Kadıköylü G. Gebelik ve kalıtsal trombofili. ADÜ Tıp Fakültesi Dergisi 2005;6:43–50.
  • 15. Goto M, Yoshizato T, Tatsumura M. Safety and efficacy of thromboprophylaxis using enoxaparin sodium after cesarean section: A multi-centerstudy in Japan. Taiwan J ObstetGynecol.2015;54:248-252.
  • 16. Schulman S, Beyth RJ, Kearon C, Levine MN. American College of Chest Physicians. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133:257–298.
  • 17. Sagaram D, Siddiq Z, Eisenberger AB. Heparin-Induced Thrombocytopenia during Obstetric Hospital Admissions. Am J Perinatol. 2018;35:898-903.
  • 18. Rodger M. Pregnancy and venous thromboembolism: ‘TIPPS’ for risk stratification. HematologyAm. Soc. Hematol. Educ. Program 2014;2014:387–392.
  • 19. Greer IA, Nelson-Piercy C. Low-molecular weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 2005;106:401–407.
  • 20. Bauersachs RM, Dudenhausen J, Faridi A. Risk stratification and heparin prophylaxis to prevent venous thromboembolism in pregnant women. ThrombHaemost 2007;98:1237–1245.
  • 21. Kotaska A. Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence-based lens. BJOG. 2018;125:1109-1116.
  • 22. Watanabe T, Matsubara S, Usui R, Izumi A, Kuwata T, Suzuki M. No increase in hemorrhagic complications with thromboprophylaxis using low-molecular-weight heparin soon after cesarean section. J ObstetGynaecol Res. 2011 Sep;37(9):1208-1211.
  • 23. Arepally GM. Heparin-induced thrombocytopenia. Blood. 2017;129:2864-2872.
  • 24. Cuker A, Arepally GM, Chong BH. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv. 2018;2:3360-3392. Shelkrot M, Miraka J, Perez ME. Appropriate enoxaparin dose for venous thromboembolism prophylaxis in patients with extreme obesity. Hosp Pharm. 2014 Sep;49(8):740-747.

Sezaryen Sonrası Tromboprofilaksi için İki Farklı Enoksaparin Dozunun Güvenirliğinin Karşılaştırılması

Yıl 2022, Cilt: 39 Sayı: 1, 62 - 65, 01.01.2022

Öz

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.

Kaynakça

  • 1. Thromboembolism in pregnancy. Practice Bulletin No. 123. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011; 118:718–729.
  • 2. T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu. Riskli Gebelikler Yönetim Rehberi. 2014, Ankara.
  • 3. Kotaska A. Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence-based lens. BJOG. 2018;125:1109-1116.
  • 4. Bıyık İ. Sezaryen Sonrası Tromboflaksisinin Uygulanan Olguların Değerlendirilmesi. ACU Sağlık Bil Derg 2020; 11(4):641-645.
  • 5. T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu. Gebelikte venöz tromboembolizm yönetim rehberi. 2017, Ankara.
  • 6. Royal College of Obstetricians and Gynaecologists Green-Top Guideline No. 37a: Reducing the Risk of Thrombosis and Embolism During Pregnancy and the Puerperium. London: RCOG, 2015.
  • 7. Sénat MV, Sentilhes L, Battut A. Postpartum practice: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J ObstetGynecolReprodBiol.2016;202:1-8.
  • 8. Lindqvist PG, Hellgren M. Obstetric thromboprophylaxis: the Swedish guidelines. AdvHematol. 2011;2011:157483.
  • 9. Nystrom PO, Jonstam A, Hojer G, Ling L. Incisional infection after colorectal surgery in obese patients. ActaChirScand 1987; 153: 225-227.
  • 10. Samama MM. Epidemiology of risk factors of deep venous thrombosis (DVT) of the lower limbs in community practice: the SIRIUS study. ThrombHaemost 1993;769:763.
  • 11. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd. Risk factors for deep vein thrombosis and pulmonary embolism: A population-basedcase-control study. ArchInternMed 2000;160(6):809–815.
  • 12. Alikhan R, Cohen AT, Combe S. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness: Analysis of the MEDENOX Study. ArchInternMed 2004;164(9):963–968.
  • 13. Shannon M. Bates. Treatment and prophylaxis of venous thromboembolism during pregnancy. ThrombosisResearch 2003;108:97–106.
  • 14. Kafkas S, Kadıköylü G. Gebelik ve kalıtsal trombofili. ADÜ Tıp Fakültesi Dergisi 2005;6:43–50.
  • 15. Goto M, Yoshizato T, Tatsumura M. Safety and efficacy of thromboprophylaxis using enoxaparin sodium after cesarean section: A multi-centerstudy in Japan. Taiwan J ObstetGynecol.2015;54:248-252.
  • 16. Schulman S, Beyth RJ, Kearon C, Levine MN. American College of Chest Physicians. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133:257–298.
  • 17. Sagaram D, Siddiq Z, Eisenberger AB. Heparin-Induced Thrombocytopenia during Obstetric Hospital Admissions. Am J Perinatol. 2018;35:898-903.
  • 18. Rodger M. Pregnancy and venous thromboembolism: ‘TIPPS’ for risk stratification. HematologyAm. Soc. Hematol. Educ. Program 2014;2014:387–392.
  • 19. Greer IA, Nelson-Piercy C. Low-molecular weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 2005;106:401–407.
  • 20. Bauersachs RM, Dudenhausen J, Faridi A. Risk stratification and heparin prophylaxis to prevent venous thromboembolism in pregnant women. ThrombHaemost 2007;98:1237–1245.
  • 21. Kotaska A. Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence-based lens. BJOG. 2018;125:1109-1116.
  • 22. Watanabe T, Matsubara S, Usui R, Izumi A, Kuwata T, Suzuki M. No increase in hemorrhagic complications with thromboprophylaxis using low-molecular-weight heparin soon after cesarean section. J ObstetGynaecol Res. 2011 Sep;37(9):1208-1211.
  • 23. Arepally GM. Heparin-induced thrombocytopenia. Blood. 2017;129:2864-2872.
  • 24. Cuker A, Arepally GM, Chong BH. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv. 2018;2:3360-3392. Shelkrot M, Miraka J, Perez ME. Appropriate enoxaparin dose for venous thromboembolism prophylaxis in patients with extreme obesity. Hosp Pharm. 2014 Sep;49(8):740-747.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Clinical Research
Yazarlar

Bugra Sahin 0000-0003-0429-3085

Gizem Cura Şahin 0000-0001-5696-4683

Erken Görünüm Tarihi 3 Ocak 2022
Yayımlanma Tarihi 1 Ocak 2022
Gönderilme Tarihi 16 Mayıs 2021
Kabul Tarihi 12 Haziran 2021
Yayımlandığı Sayı Yıl 2022 Cilt: 39 Sayı: 1

Kaynak Göster

APA Sahin, B., & Cura Şahin, G. (2022). A comparison of the safety of two different enoxaparin doses for thromboprophylaxis following cesarean section. Journal of Experimental and Clinical Medicine, 39(1), 62-65.
AMA Sahin B, Cura Şahin G. A comparison of the safety of two different enoxaparin doses for thromboprophylaxis following cesarean section. J. Exp. Clin. Med. Ocak 2022;39(1):62-65.
Chicago Sahin, Bugra, ve Gizem Cura Şahin. “A Comparison of the Safety of Two Different Enoxaparin Doses for Thromboprophylaxis Following Cesarean Section”. Journal of Experimental and Clinical Medicine 39, sy. 1 (Ocak 2022): 62-65.
EndNote Sahin B, Cura Şahin G (01 Ocak 2022) A comparison of the safety of two different enoxaparin doses for thromboprophylaxis following cesarean section. Journal of Experimental and Clinical Medicine 39 1 62–65.
IEEE B. Sahin ve G. Cura Şahin, “A comparison of the safety of two different enoxaparin doses for thromboprophylaxis following cesarean section”, J. Exp. Clin. Med., c. 39, sy. 1, ss. 62–65, 2022.
ISNAD Sahin, Bugra - Cura Şahin, Gizem. “A Comparison of the Safety of Two Different Enoxaparin Doses for Thromboprophylaxis Following Cesarean Section”. Journal of Experimental and Clinical Medicine 39/1 (Ocak 2022), 62-65.
JAMA Sahin B, Cura Şahin G. A comparison of the safety of two different enoxaparin doses for thromboprophylaxis following cesarean section. J. Exp. Clin. Med. 2022;39:62–65.
MLA Sahin, Bugra ve Gizem Cura Şahin. “A Comparison of the Safety of Two Different Enoxaparin Doses for Thromboprophylaxis Following Cesarean Section”. Journal of Experimental and Clinical Medicine, c. 39, sy. 1, 2022, ss. 62-65.
Vancouver Sahin B, Cura Şahin G. A comparison of the safety of two different enoxaparin doses for thromboprophylaxis following cesarean section. J. Exp. Clin. Med. 2022;39(1):62-5.