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首页> 外文期刊>Journal of obstetrics and gynaecology: the journal of the Institute of Obstetrics and Gynaecology >Enoxaparin administration within 24hours of caesarean section: a 6-year single-centre experience and patient outcomes
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Enoxaparin administration within 24hours of caesarean section: a 6-year single-centre experience and patient outcomes

机译：在剖腹产24小时内的烯诺拉突给药：6年的单中心经验和患者结果

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A caesarean section (CS) is a major risk factor for a venous thromboembolism, and enoxaparin, a low-molecular-weight heparin, has been widely used for thromboprophylaxis. However, it remains unclear whether an enoxaparin thromboprophylaxis has an acceptable safety profile when given early after CS compared to delayed administration, especially in the presence of an epidural catheter. This study aimed to survey cases in which enoxaparin administration was performed within 24hours of CS and to evaluate patient outcomes with or without epidural anaesthesia. The number of eligible cases were 578: 328 patients received an epidural anaesthesia (epidural group), and 250 did not (non-epidural group). In both groups, no patient developed a spinal epidural haematoma. A wound or a subcutaneous bleeding occurred in 22 (6.7%) and 20 (8.0%) cases in the epidural and non-epidural groups, respectively. One patient developed a mild pulmonary embolism, and one case of asymptomatic deep vein thrombosis was detected. An enoxaparin administration within 24hours of CS appears to be reasonable, regardless of an epidural anaesthesia. Impact statementWhat is already known on this subject? A venous thromboembolism (VTE) after a caesarean section (CS) remains a significant cause of maternal morbidity and mortality. Therefore, a thromboprophylaxis using enoxaparin, a low-molecular-weight heparin, has been widely recommended and accepted. However, there is no consensus regarding the optimal timing to initiate an enoxaparin administration after CS in the presence of an epidural catheter.What do the results of this study add? This is the largest study that has collected cases receiving enoxaparin within 24hours of a CS. Irrespective of the presence of an epidural catheter, no patient developed a spinal epidural haematoma after an early administration of enoxaparin. Furthermore, the incidence of haemorrhagic complications did not increase.What are the implications of these findings for clinical practice and/or further research? Given the significant incidence of VTE after CS and the extremely low frequency of spinal epidural haematomas, it can be justified to initiate thromboprophylaxis with enoxaparin soon after CS. However, appropriately designed, large clinical trials are necessary to examine the safety and efficacy of an early enoxaparin administration after CS. Based on such studies, the starting time of thromboprophylaxis after a CS should be decided.
机译：剖腹产部分（CS）是静脉血栓栓塞的主要危险因素，而烯脱蒿素，低分子量肝素已被广泛用于血浆丙基丙基。然而，在与延迟给药相比，在CS的早期给出时，仍然不清楚脑己蛋白血浆丙基吡酰基是否具有可接受的安全性曲线，特别是在硬膜外导管的存在下。本研究旨在调查脑癌素给药在24小时内进行的病例，并评估有或没有硬膜外麻醉的患者结果。符合条件案件的数量为578：328名患者接受了硬膜外麻醉（硬膜外组），250例没有（非硬膜外群）。在两组中，没有患者患有脊柱硬膜外血肿。伤口或皮下出血分别发生在外膜和非硬膜外群中的22（6.7％）和20例（8.0％）和20例中发生。一名患者开发了一种温和的肺栓塞，检测到一种无症状深静脉血栓形成的情况。无论硬膜外麻醉如何，在CS的24小时内才能合理，脑蛋白蛋白给药似乎是合理的。影响声明在这个主题上已经知道了什么？剖腹产（CS）后静脉血栓栓塞（VTE）仍然是母体发病率和死亡率的重要原因。因此，广泛推荐和接受使用丙氨酸，低分子量肝素的血管丙基丙基吡咯。然而，在硬膜外导管存在下，在CS的存在后，在CS后开始最佳时序没有共识。本研究的结果添加了什么？这是收集在CS的24小时内接受脑蛋白的病例的最大研究。无论硬膜外导管的存在如何，在早期施用Enoxaparin后，没有患者在脊柱后血肿发生。此外，出血性并发症的发生率并未增加。这些发现对临床实践和/或进一步研究的影响是什么？鉴于CS和脊柱硬膜外血管瘤的极低频率后VTE的显着发病率，在CS之后，它可以很快用烯脱蒿素引发缩氧丙基蛋白。然而，适当设计的大型临床试验是在CS后鉴别早期亚诺帕林给药的安全性和有效性。基于这些研究，应决定CS后血栓丙基丙基丙基乙基的起始时间。

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