Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women: a single-center observation study of Chinese Han population
Abstract Background Venous thromboembolism (VTE) is most prevalent among parturients following a cesarean section (CS). The objective of this study was to assess the practical utility of bilateral compression ultrasonography (CUS) of the lower limbs, coupled with D-dimer monitoring, in the early dia...
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-024-06372-8 |
| _version_ | 1797266580525023232 |
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| author | Xiuying Chen Haiyan Jiang Aiping Zhou Quan Zhang Minmin Du Yun Sun Baihui Zhao |
| author_facet | Xiuying Chen Haiyan Jiang Aiping Zhou Quan Zhang Minmin Du Yun Sun Baihui Zhao |
| author_sort | Xiuying Chen |
| collection | DOAJ |
| description | Abstract Background Venous thromboembolism (VTE) is most prevalent among parturients following a cesarean section (CS). The objective of this study was to assess the practical utility of bilateral compression ultrasonography (CUS) of the lower limbs, coupled with D-dimer monitoring, in the early diagnosis of VTE within the Han Chinese population. Methods Our prospective observational study included 742 women who underwent CUS and D-dimer testing on the first day post-CS. Subsequently, telephone or outpatient follow-ups were conducted until 42 days postpartum. States of hypercoagulation and thrombosis, as indicated by CUS, were classified as CUS abnormal. A D-dimer level ≥ 3 mg/l was considered the D-dimer warning value. Early ambulation and mechanical prophylaxis were universally recommended for all parturients post-CS. A sequential diagnostic strategy, based on the 2015 RCOG VTE risk-assessment tool, was employed. Therapeutic doses of low-molecular-weight heparin (LMWH) were administered for the treatment of thromboembolic disease. Prophylactic doses of LMWH were given for VTE prophylaxis in parturients with hypercoagulative status accompanied by D-dimer levels ≥ 3 mg/l. All high-risk women (RCOG score ≥ 4 points) were additionally treated with preventive LMWH. Statistical analyses were conducted using the R statistical software, with a two-sided P value < 0.05 considered statistically significant. Results Fifteen cases of VTE and 727 instances without VTE were observed. The overall VTE rate post-CS was 2.02% (15/742), with 66.7% (10/15) being asymptomatic. Eleven patients received a VTE diagnosis on the first postpartum day. Among the 41 parturients exhibiting hypercoagulation ultrasound findings and D-dimer levels ≥ 3 mg/l, despite receiving pharmacological VTE prophylaxis with LMWH, 4.88% (2/41) in the high-risk group were eventually diagnosed with VTE. A total of 30.86% (229/742) exhibited normal ultrasound findings and D-dimer levels < 3 mg/l on the first day post-CS, with no VTE occurrences in the postpartum follow-up. According to RCOG’s recommendation, 78.03% (579/742) of cesarean delivery women should receive prophylactic anticoagulation, while only 20.62% (153/742) met our criterion for prophylactic anticoagulation. Conclusion The strategy of timely routine bilateral CUS and D-dimer monitoring is conducive to the early diagnosis and treatment of VTE, significantly reducing the use of LMWH in the Chinese Han population. |
| first_indexed | 2024-04-25T01:02:57Z |
| format | Article |
| id | doaj.art-a035eb8d09584543b10e4765b79188ec |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-04-25T01:02:57Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
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| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-a035eb8d09584543b10e4765b79188ec2024-03-10T12:24:01ZengBMCBMC Pregnancy and Childbirth1471-23932024-03-012411710.1186/s12884-024-06372-8Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women: a single-center observation study of Chinese Han populationXiuying Chen0Haiyan Jiang1Aiping Zhou2Quan Zhang3Minmin Du4Yun Sun5Baihui Zhao6Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, Zhejiang University School of MedicineDepartment of Obstetrics and Gynecology, The Fourth Affiliated Hospital, Zhejiang University School of MedicineDepartment of Obstetrics and Gynecology, The Fourth Affiliated Hospital, Zhejiang University School of MedicineDepartment of Obstetrics and Gynecology, The Fourth Affiliated Hospital, Zhejiang University School of MedicineDepartment of Obstetrics and Gynecology, The Fourth Affiliated Hospital, Zhejiang University School of MedicineDepartment of Obstetrics and Gynecology, The Affiliated Taian City Central Hospital of Qingdao UniversityDepartment of Obstetrics and Gynecology, The Fourth Affiliated Hospital, Zhejiang University School of MedicineAbstract Background Venous thromboembolism (VTE) is most prevalent among parturients following a cesarean section (CS). The objective of this study was to assess the practical utility of bilateral compression ultrasonography (CUS) of the lower limbs, coupled with D-dimer monitoring, in the early diagnosis of VTE within the Han Chinese population. Methods Our prospective observational study included 742 women who underwent CUS and D-dimer testing on the first day post-CS. Subsequently, telephone or outpatient follow-ups were conducted until 42 days postpartum. States of hypercoagulation and thrombosis, as indicated by CUS, were classified as CUS abnormal. A D-dimer level ≥ 3 mg/l was considered the D-dimer warning value. Early ambulation and mechanical prophylaxis were universally recommended for all parturients post-CS. A sequential diagnostic strategy, based on the 2015 RCOG VTE risk-assessment tool, was employed. Therapeutic doses of low-molecular-weight heparin (LMWH) were administered for the treatment of thromboembolic disease. Prophylactic doses of LMWH were given for VTE prophylaxis in parturients with hypercoagulative status accompanied by D-dimer levels ≥ 3 mg/l. All high-risk women (RCOG score ≥ 4 points) were additionally treated with preventive LMWH. Statistical analyses were conducted using the R statistical software, with a two-sided P value < 0.05 considered statistically significant. Results Fifteen cases of VTE and 727 instances without VTE were observed. The overall VTE rate post-CS was 2.02% (15/742), with 66.7% (10/15) being asymptomatic. Eleven patients received a VTE diagnosis on the first postpartum day. Among the 41 parturients exhibiting hypercoagulation ultrasound findings and D-dimer levels ≥ 3 mg/l, despite receiving pharmacological VTE prophylaxis with LMWH, 4.88% (2/41) in the high-risk group were eventually diagnosed with VTE. A total of 30.86% (229/742) exhibited normal ultrasound findings and D-dimer levels < 3 mg/l on the first day post-CS, with no VTE occurrences in the postpartum follow-up. According to RCOG’s recommendation, 78.03% (579/742) of cesarean delivery women should receive prophylactic anticoagulation, while only 20.62% (153/742) met our criterion for prophylactic anticoagulation. Conclusion The strategy of timely routine bilateral CUS and D-dimer monitoring is conducive to the early diagnosis and treatment of VTE, significantly reducing the use of LMWH in the Chinese Han population.https://doi.org/10.1186/s12884-024-06372-8Bilateral compression ultrasonographyD-dimerProphylaxisDiagnosisDeep venous thrombosisCesarean section |
| spellingShingle | Xiuying Chen Haiyan Jiang Aiping Zhou Quan Zhang Minmin Du Yun Sun Baihui Zhao Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women: a single-center observation study of Chinese Han population BMC Pregnancy and Childbirth Bilateral compression ultrasonography D-dimer Prophylaxis Diagnosis Deep venous thrombosis Cesarean section |
| title | Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women: a single-center observation study of Chinese Han population |
| title_full | Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women: a single-center observation study of Chinese Han population |
| title_fullStr | Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women: a single-center observation study of Chinese Han population |
| title_full_unstemmed | Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women: a single-center observation study of Chinese Han population |
| title_short | Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women: a single-center observation study of Chinese Han population |
| title_sort | is early bilateral compression ultrasonography and d dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women a single center observation study of chinese han population |
| topic | Bilateral compression ultrasonography D-dimer Prophylaxis Diagnosis Deep venous thrombosis Cesarean section |
| url | https://doi.org/10.1186/s12884-024-06372-8 |
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