在美国队列中产后药理性血栓预防和并发症
Ann M Bruno1, Grecio J Sandoval2, Brenna L Hughes3
1Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT.
American journal of obstetrics and gynecology
|February 12, 2024
概括
大约10分之一的患者接受了产后药理性血栓预防治疗,其比例因机构而异. 剖腹产,子宫切除术和肥胖是与其管理相关的关键因素.
科学领域:
- 产科和妇科 产科和妇科
- 心脏病学 心脏病学
- 公共卫生 公共卫生
背景情况:
- 静脉血栓塞栓症 (VTE) 是美国与怀孕有关的死亡的一个重要原因.
- 国家指导方针提倡产后静脉瘤风险评估和药物预防.
- 目前关于产后药理性血栓预防率和相关风险的数据有限.
研究的目的:
- 为了确定产后药理性血栓预防的发生率.
- 确定与其启动相关的因素.
- 评估与其管理相关的不良结果.
主要方法:
- 一项多中心队列研究 (2019-2020年) 的二次分析,涉及21,114人.
- 排除患有产前VTE,抗凝血或SARS-CoV-2感染的患者.
- 多变量回归和倾向得分调整以分析预防药物管理和结果.
主要成果:
- 11.9%的患者接受了产后药理性血栓预防治疗.
- 预防率在各机构之间差异很大 (0.21%至34.8%).
- 剖腹产 (aOR 19.17),子宫切除术 (aOR 15.70) 和肥胖 (aOR 3.45) 与预防有很强的关联.
- 在预防和手术部位感染,出血或再入院之间没有发现显著的关联.
- 静脉瘤发作率为0.06%,在接受预防治疗的人群中 (0.2%) 和未接受预防治疗的人群中 (0.04%) 的比例更高.
结论:
- 在美国,近十分之一的患者接受了产后药理性血栓预防治疗.
- 预防率存在显著的机构差异.
- 剖腹产,子宫切除术和肥胖是影响预防药物管理的主要因素.
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