| Objective:To investigate the effectiveness and safety of prophylactic anticoagulation therapy after cesarean section for women with VTE risk factors in preventing venous thromboembolism(VTE),and provide clinical evidence for the antithrombotic prophylaxis therapy after cesarean section.Materials and methods:100 women of elective cesarean section with high VTE risk factors and 50 women of elective cesarean section without high VTE risk factors due to breech presentation,macrosomia and cephalopelvic disproportion were selected from the second Hospital of Jilin University from July to December in 2020.The operation method was all lower uterine cesarean section,and combined spinal-epidural analgesia was used in all patients.The operation time of all patients was less than 60 min,and hemostatic drugs were not usually used during and after the operation.Randomly dividing the high-risk group with one or more VTE high-risk factors into high-risk group 1 and high-risk group 2,and those women without high-risk factors was the normal group.High-risk group 1: LMWH 4100 AXa IU was given to them 12 h after the cesarean section,once a day for 5 consecutive days;High-risk group 2 and the normal group: No prophylactic medication.All the patients of the three groups took elbow vein blood before and 3 days after the cesarean section to test coagulation routine,blood routine,TEG(thromboelastogram),lower limbs deep vein ultrasound in patients with lower limb swelling and pain,and blood coagulation routine in outpatient clinic 6 weeks after delivery.Then compare the routine coagulation(APTT,PT,FIB,FDPS,D-Dimer),platelet count(PLT),mean platelet volume(MPV),TEG(R,K,α Angle,MA,LY30,EPL),the incidence of venous thrombosis and postpartum hemorrhage of the three groups before and 3 days after the surgery,plus the routine coagulation the 6 weeks after delivery.Results:1.Comparison of platelet parameters: there was no apparent difference in PLT between high-risk group 1,high-risk group 2 and the normal group before and after operation(P>0.05),but all MPV level decreased after the surgery(P<0.05).The PLT and MPV among high-risk group 1,high-risk group 2 and normal group before operation were not significantly different as well as the PLT and MPV after operation among the three groups(P>0.05).2.Comparison of blood coagulation routine parameters: the APTT,FIB,FDPs and D-Dimer before and after operation in high-risk group 1 are not very different(P >0.05),but PT after operation was apparently longer than that before operation(P<0.05).The PT before and after operation in high-risk group 2 was not very different(P > 0.05),but APTT was shortened,FIB,FDPs and D-Dimer were hugely increased(P<0.05).In the normal group,there was no difference in APTT,FIB,FDPs and D-Dimer before and after operation(P > 0.05),but the PT after operation was longer than that before operation(P<0.05).The FIB,FDPs and D-Dimer before operation in high-risk group1,high-risk group 2 and normal group were all higher than the normal value,but there was no statistical difference in PT,APTT,FIB,FDPs and D-Dimer among the three groups(P>0.05).There was no significant difference in FIB、FDPs、D-Dimer after operation among high-risk group 1,high-risk group 2 and the normal group(P>0.05),but there was statistical difference in PT and APTT(P<0.05),among them,PT and APTT in high-risk group 1 were longer than those in high risk group 2(P<0.05).There was no significant difference in FDPs of 132 women among high risk group 1,high risk group 2 and normal group at 6 weeks after delivery(P>0.05),but there were apparent differences in PT,APTT,FIB and D-Dimer among the three groups(P<0.05),but they were all within the normal reference range,PT and APTT in high-risk group 1 were higher than those in high-risk group 2(P<0.05),while FIB and D-Dimer were less than those in high-risk group 2(P<0.05);The APTT in high-risk group 1 was apparently higher than that in normal group(P<0.05);The PT in high-risk group 2 was lower than that in normal group(P<0.05).3.Comparison of TEG parameters: there was no significant difference in K value,α angle,MA,LY30 and EPL before and after operation in high-risk group 1(P>0.05),but the R value after operation was significantly lower than that before operation(P<0.05).There was no apparent difference in α angle,LY30 and EPL in high-risk group 2 before and after operation(P>0.05),but the R and K values decreased and MA increased after operation than those before operation(P<0.05).In the normal group,there was no difference in LY30 and EPL before and after operation(P>0.05),but the R、K values decreased and α angle、MA increased after operation than those before operation(P<0.05).There was no outstanding difference in R value,K value,α angle,LY30 and EPL among high risk-group 1,high-risk group 2 and normal group before operation(P>0.05),but MA is apparently different among the three groups(P<0.05);then compare them in pairs,the MA in high-risk group 1 was higher than that in normal group(P<0.05).The α angle,MA,LY30 and EPL level among the three groups after operation are not apparently different(P>0.05),but there was significant difference in R value and K value among the three groups(P<0.05);the R value of high-risk group 2was lower than that of normal group(P<0.05),and the K value of high-risk group 2 was lower than that of high-risk group 1(P<0.05).Conclusion:1.Prophylactic use of LMWH after cesarean section doesn’t increase the risk of postpartum hemorrhage and other bleeding events,and the adverse reactions are mild.2.TEG is more sensitive and accurate than blood coagulation test in reflecting real blood coagulation.3.LMWH prophylactic anticoagulation after cesarean section in the woman with high VTE risk factors can significantly improve the hypercoagulable state of maternal blood and affect the degree of blood coagulation recovery after delivery.4.VTE high-risk women after cesarean section can consider be used prophylactic high-dose(medium-dose)LMWH to prevent VTE. |
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