ANTITHROMBOTIC THERAPY IN PATIENTS WITH METABOLIC SYNDROME AFTER ABDOMINAL DELIVERY

Abstract

Objective. To assess the effectiveness for complex antithrombotic therapy with low molecular weight heparins (LMWH) after cesarean section at women with metabolic syndrome (MS). Materials and Methods. The study included 115 patients with metabolic syndrome after cesarean section. Group 1 (64 patients) with metabolic syndrome who had a complicated pregnancy in history. Group 2 (51 patient) with metabolic syndrome and no pregnancies in anamnesis. Group 3 (50 patients) – somatically healthy mothers. С omprehensive clinical and laboratory examination was conducted, including a study of indicators of hemostasis in the preoperative period and at 1-th, 3-4-th, 9-10-th day of postoperative period. To prevent thromboembolic complications all patients with metabolic syndrome were injected enoxaparin sodium 12 hours after abdominal delivery in a dose of 40 mg daily, with further dose adjustment. Results. According to the results of studies in patients with MS from 1 day of the postoperative period there was an increased prothrombotic potential, violation of indicators of coagulation, platelet hemostasis and the system of natural anticoagulants. Due to the therapy with the use of LMWH the development of thromboembolic episodes was prevented at all patients with MC in the postoperative period. Other complications of the postoperative period were detected in 17 (14.78%) of patients with MS and 7 (14.00%) somatically healthy mothers. The incidence of postoperative complications 1st and 2nd groups were comparable with 3rd group. Analysis of laboratory parameters in patients with metabolic syndrome with complicated postoperative period, showed that the aggregation capacity of platelets with ADP, the levels of TAT and D-dimer on 9-10th day were comparable with those indices in the 1st and 3-4th day. The results show prothrombotic tendencies and violations of the hemostatic system continued to 9-10 days in these patients and also indicate a pathogenetic relationship of these tendencies in the development of postoperative complications. Conclusion. The development of thromboembolic complications in patients with MC was prevented due to the therapy of LMWH.