Профілактика венозного тромбоемболізму у вагітних груп ризику: клініко-інструментальне дослідження

Abstract

The objective: of our research was to examine the efficiency and safety of enoxaparin domestic production (Flenox, JSC «Farmak», Ukraine) in women during pregnancy and puerperium which included moderate and high risk of venous thromboembolism (VTE). Patients and methods. There were 32 pregnant women under observation, who belonged to the moderate and high risk of VTE (RCOG, 2009). At all patients was defined the condition of a venous blood flow of the lower extremities (duplex scanning) and clinical tests. The study was conducted before treatment or before delivery and 5–7 days after birth. During pregnancy, 18 patients with high risk of VTE received thromboprophylaxis. In the puerperium, all 32 patients received Flenox: a group of moderate risk of VTE within 10 days, with high risk – 6 weeks. Results. Among the patients in 31.25% were diagnosed congenital and acquired thrombophilia. 9.4% of pregnant women had long bed rest, 21.9% received thromboprophylaxis because of severe cardiac disease. In 18.75% were diagnosed systemic lupus erythematosus in 15.6% severe preeclampsia. In 5 patients thrombosis and embolism diagnosed before pregnancy to 3 patiens during this pregnancy, 2 as a history, and in this pregnancy (due to late start of thromboprophylaxis). Somatic pathology occurred in all cases, varicose veins was in 12 (37.5%) pregnants. Burdened obstetric and gynecological history were at all women. The most common complications of pregnancy were: the risk of spontaneous miscarriage (53.1%) and preterm birth (28.1%), preterm aging of the placenta (43.75%), anemia (18.75%). Vaginal childbirth was in 62.5% and 37.5% of patients given birth by cesarean section. The average blood loss in vaginal deliveries was 186±90 ml, during cesarean section 520±50 ml. Most babies (68.75%) were born in a satisfactory condition and did not have any signs of negative effects of the drug, including bleeding complications. The treatment had not significant effect on the overall performance of complete blood count, urinalysis, coagulation. Lack of the thrombosis during pregnancy in women at high risk of VTE and postpartum women which had middle and high risk is a sign of the effectiveness of the treatment. Conclusion. Enoxaparin (Flenox) production of «Farmak» (Ukraine) is effective and safe means of thromboprophylaxis at women during pregnancy and the puerperal period which have moderate and high risk of development of VTE. Key words: venous thromboembolism, pregnancy, delivery, Flenox.