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Filip C, Matasariu DR, Ursache A, Furnica C, Anton GI, Filip C, Boiculese VL, Socolov DG, Chistol RO. Predictive Value of Centered Clinical Asymmetric Lower Limb Edema in Diagnosing Deep Vein Thrombosis in Puerperium. J Clin Med 2025; 14:3320. [PMID: 40429316 PMCID: PMC12112132 DOI: 10.3390/jcm14103320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2025] [Revised: 05/04/2025] [Accepted: 05/08/2025] [Indexed: 05/29/2025] Open
Abstract
Background: Peripheral vein thrombosis during pregnancy poses serious diagnostic challenges due to the intertwining of its clinical symptoms with normal pregnancy modifications. Methods: We analyzed and compared the paraclinical test results of singleton pregnant women and women in the first six weeks postpartum who presented with significant lower limb inequality. Results: Our data revealed three predictors of deep vein thrombosis (DVT): mean platelet volume (MPV), with a one-unit increase in MPV being associated with a 1.497-fold higher risk of thrombosis (p = 0.008); platelet distribution width (PDW), with a one-unit decrease in PDW increasing thrombosis risk (odds ratio (OR) = 1.17, p = 0.003); anemia, with its presence increasing the risk of thrombosis by 8.46 times (p = 0.003); and fibrinogen, with a one-unit increase in its level increasing DVT risk 1.003-fold. Conclusions: Significant lower limb inequality might be used as a predictor of DVT during puerperium.
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Affiliation(s)
- Catalina Filip
- Department of Vascular Surgery, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania;
- Department of Vascular Surgery, CHU “Gabriel Montpied”, 63000 Clermont-Ferrand, France
| | - Daniela Roxana Matasariu
- Department of Mother and Child Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (A.U.); (D.G.S.)
- Department of Obstetrics and Gynecology, Cuza Voda Hospital, 700038 Iasi, Romania;
| | - Alexandra Ursache
- Department of Mother and Child Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (A.U.); (D.G.S.)
| | - Cristina Furnica
- Department of Morpho-Functional Sciences I, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, (R.O.C.)
- Institute of Forensic Medicine, 700455 Iasi, Romania
| | - Gabriel Ioan Anton
- Department of Obstetrics and Gynecology, Cuza Voda Hospital, 700038 Iasi, Romania;
| | - Cristiana Filip
- Department of Biochemistry, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania;
| | - Vasile Lucian Boiculese
- Biostatistics, Department of Preventive Medicine and Interdisciplinarity, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania;
| | - Demetra Gabriela Socolov
- Department of Mother and Child Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (A.U.); (D.G.S.)
- Department of Obstetrics and Gynecology, Cuza Voda Hospital, 700038 Iasi, Romania;
| | - Raluca Ozana Chistol
- Department of Morpho-Functional Sciences I, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, (R.O.C.)
- Department of Medical Imaging, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, 700503 Iasi, Romania
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Shapero K, Madden T. The 2024 US Medical Eligibility Criteria for Contraceptive Use: Application to Practice in the Care of Patients With Cardiac Disease. Circ Res 2025; 136:566-582. [PMID: 40080533 DOI: 10.1161/circresaha.125.325682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Revised: 02/04/2025] [Accepted: 02/11/2025] [Indexed: 03/15/2025]
Abstract
Cardiovascular disease is the leading cause of maternal mortality in the United States, with the majority of deaths stemming from preventable causes. Contraception is one of the tools that can be utilized to prevent mortality and morbidity associated with unplanned pregnancy in patients with underlying congenital or acquired heart disease. There are a wide range of contraceptive methods available. While some methods, especially those containing estrogen, may be associated with increased risks in certain cardiac disease states, intrauterine devices, implants, and progestin-only methods may be safely used by the vast majority of patients with cardiac disease. Furthermore, intrauterine devices and implants are the most effective reversible contraceptive methods available. This review provides a summary of the US Centers for Disease Control and Prevention 2024 Medical Eligibility Criteria for Contraceptive Use as it applies to cardiac disease states. This review emphasizes the importance of contraceptive counseling and aims to familiarize the reader with the various forms of contraception available to patients, as well as the risks and benefits of each method in patients with different types of cardiac disease.
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Affiliation(s)
- Kayle Shapero
- Brown University Health Cardiovascular Institute, Providence, RI (K.S.)
| | - Tessa Madden
- Department of Obstetrics, Gynecology, and Reproductive Science, Yale School of Medicine, New Haven, CT (T.M.)
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Ahmed AFE, Zachariah S, Ismail AH, Gibson CM. Variation among venous thromboembolism risk assessment tools for postcesarean patients: a retrospective cohort study. Blood Coagul Fibrinolysis 2024; 35:357-361. [PMID: 39397735 DOI: 10.1097/mbc.0000000000001325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 08/23/2024] [Indexed: 10/15/2024]
Abstract
Venous thromboembolism (VTE) risk in pregnant women is four to five-fold higher than in nonpregnant women, and the risk of VTE is an additional four-fold higher after Cesarean section compared to normal vaginal delivery. Recommendations regarding anticoagulant prophylaxis are inconsistent across international guidelines, and VTE remains one of the leading causes of maternal morbidity and mortality. This study aimed to compare the need for postcesarean anticoagulation for VTE prophylaxis based on three major guidelines and our own institutional protocol. It was a retrospective cohort study that reviewed the medical records of patients who underwent a cesarean section at a tertiary-level care hospital in the United Arab Emirates (UAE). The need for anticoagulation was assessed using clinical tools from the American College of Obstetricians and Gynecologists (ACOG), Royal College Obstetricians and Gynecologists (RCOG), American College of Chest Physicians (ACCP), and the study site hospital protocol. A total of 1134 postcesarean women, aged 18-55 years, were included in the study. Most patients (87%) were at moderate risk for VTE. According to the study site hospital tool, 90.7% qualified for anticoagulant prophylaxis, while the ACOG, RCOG, and ACCP tools indicated that 0.5, 90.9, and 36.7% qualified, respectively. Enoxaparin was the primary anticoagulant used in 95% of cases. Only one patient developed VTE during the follow-up period. Anticoagulation needs assessment tools vary extensively in their estimations, highlighting the need for a uniform tool across multiple societies to establish a consistent standard of care and guide the development of evidence-based, site-specific protocols.
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Affiliation(s)
| | | | - Amal Hassan Ismail
- College of Medicine, Gulf Medical University
- Department of Obstetrics & Gynecology, Thumbay University Hospital, Ajman, United Arab Emirates
| | - Caitlin M Gibson
- School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
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4
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Jiang AYN, Abasszade JH, Abrahams T, Nan K, Low MSY, Barnes SL, Lim AN, Shen JZL. Bilateral adrenal hemorrhage in a postpartum woman with multiple thromboemboli: A case report. J Med Case Rep 2024; 18:518. [PMID: 39449152 PMCID: PMC11515325 DOI: 10.1186/s13256-024-04834-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 09/13/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Bilateral adrenal hemorrhage is a rare but often a fatal cause of primary adrenal insufficiency that can result in adrenal crisis if not identified and managed appropriately. CASE PRESENTATION We present a case of a 27-year-old Caucasian female who was admitted to the hospital 17 days postpartum with pleuritic chest and flank pain, shortness of breath and nausea. Computed tomography imaging confirmed multiple thromboemboli including pulmonary emboli and noted bilateral bulky adrenal glands. She was managed for infection and pulmonary emboli; however, she complained of persistent headaches, nausea, and vomiting despite appropriate management. Radiology re-review found the computed tomography imaging was consistent with bilateral adrenal hemorrhage in hindsight. Subsequent endocrine evaluation with hypothalamic-pituitary-adrenal axis interrogation and adrenocorticotropic hormone (Synacthen) stimulation testing confirmed resultant primary adrenal insufficiency. She required urgent intravenous hydrocortisone and was subsequently discharged on oral adrenal replacement therapy and anticoagulation. CONCLUSIONS Delay in identification and treatment of adrenal insufficiency can lead to catastrophic outcomes. This case highlights the challenge of diagnosing bilateral adrenal hemorrhage and resultant adrenal insufficiency as patients may not present with the classic risk factors, signs, symptoms, and electrolyte derangements.
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Affiliation(s)
- Anna Yi Nan Jiang
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | | | - Timothy Abrahams
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Kirollos Nan
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | | | - Sara Laura Barnes
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
- Department of Allergy and Immunology, Monash Health, Clayton, VIC, Australia
| | - Ann Nee Lim
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Jimmy Zhen Long Shen
- Department of Endocrinology, Monash Health, 246 Clayton Road, Clayton, VIC, Australia.
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC, Australia.
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Salavati M, Arabshomali A, Nouranian S, Shariat-Madar Z. Overview of Venous Thromboembolism and Emerging Therapeutic Technologies Based on Nanocarriers-Mediated Drug Delivery Systems. Molecules 2024; 29:4883. [PMID: 39459251 PMCID: PMC11510185 DOI: 10.3390/molecules29204883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 10/03/2024] [Accepted: 10/12/2024] [Indexed: 10/28/2024] Open
Abstract
Venous thromboembolism (VTE) is a serious health condition and represents an important cause of morbidity and, in some cases, mortality due to the lack of effective treatment options. According to the Centers for Disease Control and Prevention, 3 out of 10 people with VTE will have recurrence of a clotting event within ten years, presenting a significant unmet medical need. For some VTE patients, symptoms can last longer and have a higher than average risk of serious complications; in contrast, others may experience complications arising from insufficient therapies. People with VTE are initially treated with anticoagulants to prevent conditions such as stroke and to reduce the recurrence of VTE. However, thrombolytic therapy is used for people with pulmonary embolism (PE) experiencing low blood pressure or in severe cases of DVT. New drugs are under development, with the aim to ensure they are safe and effective, and may provide an additional option for the treatment of VTE. In this review, we summarize all ongoing trials evaluating anticoagulant interventions in VTE listed in clinicaltrials.gov, clarifying their underlying mechanisms and evaluating whether they prevent the progression of DVT to PE and recurrence of thrombosis. Moreover, this review summarizes the available evidence that supports the use of antiplatelet therapy for VTE. Since thrombolytic agents would cause off-target effects, targeted drug delivery platforms are used to develop various therapeutics for thrombotic diseases. We discuss the recent advances achieved with thrombus-targeting nanocarriers as well as the major challenges associated with the use of nanoparticle-based therapeutics.
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Affiliation(s)
- Masoud Salavati
- Department of Chemical Engineering, University of Mississippi, Oxford, MS 38677, USA; (M.S.); (S.N.)
| | - Arman Arabshomali
- Pharmacy Administration, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA;
| | - Sasan Nouranian
- Department of Chemical Engineering, University of Mississippi, Oxford, MS 38677, USA; (M.S.); (S.N.)
| | - Zia Shariat-Madar
- Division of Pharmacology, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
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Stančiaková L, Brisudová K, Škorňová I, Bolek T, Samoš M, Biringer K, Staško J, Sokol J. Evaluating Thromboprophylaxis Strategies for High-Risk Pregnancy: A Current Perspective. Pharmaceuticals (Basel) 2024; 17:773. [PMID: 38931440 PMCID: PMC11207010 DOI: 10.3390/ph17060773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
Venous thromboembolism (VTE) represents one of the leading causes of death during pregnancy. The greatest risk for it is the presence of medical or family history of VTE, stillbirth, cesarean section and selected thrombophilia. Appropriate thromboprophylaxis has the potential to decrease the risk of VTE in at-risk pregnant patients by 60-70%. Based on this, the authors reviewed the PubMed, Web of Science and Scopus databases to identify the possibilities of thromboprophylaxis in pregnant patients with a high risk of VTE. Moreover, they summarized its management in specific situations, such as cesarean delivery or neuraxial blockade. Currently, low-molecular-weight heparins (LMWH) are the preferred drugs for anticoagulant thromboprophylaxis in the course of pregnancy and postpartum due to easy administration and a lower rate of adverse events.
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Affiliation(s)
- Lucia Stančiaková
- National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusion Medicine, Martin University Hospital, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (I.Š.); (J.S.); (J.S.)
| | - Kristína Brisudová
- Department of Internal Medicine I., Martin University Hospital, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (K.B.); (T.B.)
| | - Ingrid Škorňová
- National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusion Medicine, Martin University Hospital, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (I.Š.); (J.S.); (J.S.)
| | - Tomáš Bolek
- Department of Internal Medicine I., Martin University Hospital, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (K.B.); (T.B.)
| | - Matej Samoš
- Department of Internal Medicine I., Martin University Hospital, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (K.B.); (T.B.)
| | - Kamil Biringer
- Department of Gynecology and Obstetrics, Martin University Hospital, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia;
| | - Ján Staško
- National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusion Medicine, Martin University Hospital, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (I.Š.); (J.S.); (J.S.)
| | - Juraj Sokol
- National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusion Medicine, Martin University Hospital, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (I.Š.); (J.S.); (J.S.)
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Aldabbour B, Abu Sidgh O, Haboush I, Jalhum E, Alsmary S, Irheem S, Elamassie S, Zimmo M, Asad MD. Factors limiting women's adherence to venous thromboembolism prophylaxis after cesarean section in the Gaza Strip: A cross-sectional study. Phlebology 2024; 39:29-36. [PMID: 37846865 DOI: 10.1177/02683555231207712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
OBJECTIVES We evaluate the rates and limitations of women's adherence to low molecular weight heparin (LMWH) after cesarean section (CS) in the Gaza Strip. METHODS Women who underwent CS were recruited consecutively. Communication offered to women, adherence to Venous thromboembolism (VTE), and its limiting factors were surveyed. RESULTS 281 women participated (mean age 27.9 years). 51.95% fully adhered to VTE prophylaxis. Causes of suboptimal adherence were: 51.1% did not feel VTE prophylaxis was important, 37.8% due to high drug cost, and 11.1% didn't receive a prescription for LMWH at discharge. Poor communication was evident as 48.8% of the sample did not receive any instructions about the technical method of LMWH injection, 45.6% did not receive any information about the clinical significance of heparin, and 74.7% were unaware of LMWH side effects. CONCLUSION There is inadequate adherence to VTE prophylaxis after CS among Gaza women, mostly due to a lack of appropriate communication but also due to drug costs.
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Affiliation(s)
- Belal Aldabbour
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Ola Abu Sidgh
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Israa Haboush
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Eman Jalhum
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Shimaa Alsmary
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Sara Irheem
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Samah Elamassie
- Health Services, United Nations Relief and Works Agency (UNRWA), Gaza, State of Palestine
| | - Mohammad Zimmo
- Obstetrics Department, Al-Shifa Medical Complex, Gaza, State of Palestine
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Dicks AB, Moussallem E, Stanbro M, Walls J, Gandhi S, Gray BH. A Comprehensive Review of Risk Factors and Thrombophilia Evaluation in Venous Thromboembolism. J Clin Med 2024; 13:362. [PMID: 38256496 PMCID: PMC10816375 DOI: 10.3390/jcm13020362] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant cause of morbidity and mortality worldwide. There are many factors, both acquired and inherited, known to increase the risk of VTE. Most of these result in increased risk via several common mechanisms including circulatory stasis, endothelial damage, or increased hypercoagulability. Overall, a risk factor can be identified in the majority of patients with VTE; however, not all risk factors carry the same predictive value. It is important for clinicians to understand the potency of each individual risk factor when managing patients who have a VTE or are at risk of developing VTE. With this, many providers consider performing a thrombophilia evaluation to further define a patient's risk. However, guidance on who to test and when to test is controversial and not always clear. This comprehensive review attempts to address these aspects/concerns by providing an overview of the multifaceted risk factors associated with VTE as well as examining the role of performing a thrombophilia evaluation, including the indications and timing of performing such an evaluation.
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Affiliation(s)
- Andrew B. Dicks
- Department of Vascular Surgery, Prisma Health, University of South Carolina School of Medicine—Greenville, Greenville, SC 29601, USA; (E.M.); (M.S.); (S.G.); (B.H.G.)
| | - Elie Moussallem
- Department of Vascular Surgery, Prisma Health, University of South Carolina School of Medicine—Greenville, Greenville, SC 29601, USA; (E.M.); (M.S.); (S.G.); (B.H.G.)
| | - Marcus Stanbro
- Department of Vascular Surgery, Prisma Health, University of South Carolina School of Medicine—Greenville, Greenville, SC 29601, USA; (E.M.); (M.S.); (S.G.); (B.H.G.)
| | - Jay Walls
- Department of Hematology, Prisma Health, University of South Carolina School of Medicine—Greenville, Greenville, SC 29601, USA;
| | - Sagar Gandhi
- Department of Vascular Surgery, Prisma Health, University of South Carolina School of Medicine—Greenville, Greenville, SC 29601, USA; (E.M.); (M.S.); (S.G.); (B.H.G.)
| | - Bruce H. Gray
- Department of Vascular Surgery, Prisma Health, University of South Carolina School of Medicine—Greenville, Greenville, SC 29601, USA; (E.M.); (M.S.); (S.G.); (B.H.G.)
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9
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Hwang HG, Lee JH, Bang SM. Incidence of Pregnancy-Associated Venous Thromboembolism: Second Nationwide Study. Thromb Haemost 2023; 123:904-910. [PMID: 36693414 DOI: 10.1055/a-2019-0607] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Pregnancy is a transient risk factor for venous thromboembolism (VTE). This second nationwide study aimed to inspect trend changes in the incidence rate of pregnancy-associated VTE (PA-VTE) during the study period (2014-2018) compared with that reported in a previous study (2006-2010). METHODS Using the Korean Health Insurance Review and Assessment Service database, we retrospectively identified all PA-VTE events using both diagnostic and medication codes. RESULTS Of the 124,228 VTE events, 510 (0.4%) cases of PA-VTE were identified in 499 women (median age: 34 years; range: 20-49 years). The incidence rate of PA-VTE/10,000 deliveries (PA-VTE/104D) in this second study (2.62) was 3.2 times higher than that in the first study (0.82). In the second study, the PA-VTE/104D ratio of women in their 40s (5.46) was three times higher than that of women in their 20s (1.80) (relative risk: 3.03; 95% confidence interval: 2.04-4.51; p < 0.01). The incidence rate for women in their 40s in the second study was 2.3 times higher than that in the first study. PA-VTE/104D cases occurred more frequently in multiparous than in primiparous women, in cesarean section cases compared with vaginal delivery, and in multiple rather than single pregnancies. Most PA-VTE cases occurred during the postpartum period (321/510, 62.9%), of which pulmonary embolism was the most frequently occurring type (231/321, 72%). CONCLUSION Advanced maternal age, cesarean section, multiparity, and multifetal pregnancies increased the risk of PA-VTE. Obstetricians need to be cautious of VTE, particularly during the postpartum period, in high-risk pregnant patients.
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Affiliation(s)
- Hun-Gyu Hwang
- Division of Respiratory, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine, Republic of Korea
| | - Ju Hyun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Azarmehr N, Porhemat R, Roustaei N, Radmanesh E, Moslemi Z, Vanda R, Barmoudeh Z, Eslamnik P, Doustimotlagh AH. Melatonin-Attenuated Oxidative Stress in High-Risk Pregnant Women Receiving Enoxaparin and Aspirin. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:9523923. [PMID: 37275576 PMCID: PMC10234730 DOI: 10.1155/2023/9523923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023]
Abstract
Objective In pregnancy, reducing inflammation and oxidative stress is important. Administration of melatonin during pregnancy can improve reproductive performance by improving the placental antioxidant system and inflammatory response. This investigation was carried out to evaluate the beneficial impact of melatonin on the oxidative stress state among high-risk pregnant women receiving enoxaparin and aspirin. Methods In this double-blind, placebo-controlled trial, 40 pregnant women, aged 15-45 years at 6 weeks of pregnancy, were randomly selected and divided into intervention and control groups. The control group received prophylaxis enoxaparin and aspirin once daily between 6 and 16 weeks of pregnancy. The intervention group was taken enoxaparin and aspirin for 9 weeks and melatonin once daily from the sixth week of pregnancy to delivery time. Blood samples were taken to measure some oxidative stress biomarkers including total antioxidant capacity (TAC), malondialdehyde (MDA), total thiol (T-SH), protein carbonyl (PCO), and nitric oxide (NO). The level of high-sensitivity C-reactive protein (hs-CRP) was also determined. Results TAC and T-SH levels increased significantly in the intervention group in comparison with the control group. Melatonin administration compared to the control group led to a significantly decreased level of NO and an insignificant hs-CRP level. Conclusion Melatonin supplementation in high-risk pregnancy had favorable effects on TAC, T-SH, NO, and hs-CRP levels, improved antioxidant activity, and reduced inflammation. More studies are needed in different pregnancy conditions along with the measurement of different biomarkers.
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Affiliation(s)
- Nahid Azarmehr
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Roghayeh Porhemat
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Narges Roustaei
- Department of Biostatistics and Epidemiology, School of Health, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Esmat Radmanesh
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
- Department of Physiology, Faculty of Medicine, Abadan University of Medical Sciences, Abadan, Iran
- Clinical Research Development Unit, Imam Sajad Educational Hospital, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zahra Moslemi
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Razieh Vanda
- Clinical Research Development Unit, Imam Sajad Educational Hospital, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zahra Barmoudeh
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Parvinsadat Eslamnik
- Department of Obstetrics and Gynecology, Imam Sajad Hospital, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Amir Hossein Doustimotlagh
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
- Clinical Research Development Unit, Imam Sajad Educational Hospital, Yasuj University of Medical Sciences, Yasuj, Iran
- Department of Clinical Biochemistry, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
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