产后血栓形成风险显著增高可持续12周

圣迭戈——对170万女性数据的分析显示，分娩后血栓形成风险的显著增高可持续至产后12周，比既往认为的血栓风险增高时段延长了1倍。该研究于2014年2月13日在线发表于《新英格兰医学杂志》 (2014 Feb. 13 [doi: 10.1056/NEJMoa1311485])。

现行指南呼吁对孕前有卒中风险增高或其他危险因素的高危女性进行产后血液稀释治疗，但尚未明确这种处理是否应延长至产后6周之后，而该研究可能指出了进一步探索这一问题的方向。

纽约州康奈尔大学神经病科的Hooman Kamel医生及其合作者分析了2005~2010年间因首次分娩而被收入加利福尼亚州非联邦急症医院或急诊室的1,687,930名女性的数据。

结果显示，其中1,015名女性于分娩后24周内发生血栓事件(0.06%)，包括卒中（248例）、心肌梗死（MI，47例）和静脉血栓栓塞（720例）。Kamel医生在国际卒中大会的新闻发布会上报告，分娩后最初6周内发生血栓事件的风险为一般人的11倍，产后7~12周内发生血栓事件的风险为一般人的2倍。产后最初6周内风险增加22例/100,000次分娩，产后7~12周内风险增加3例/100,000次分娩。分娩后13~18周，血栓形成的风险增高40%，但与1年之后相比无统计学差异。产后19~24周内的血栓形成风险恢复至与从未分娩的女性相同的水平。

研究者总结认为，产后血栓形成风险的增高可持续至12周，在此期间应警惕任何可能提示血栓的症状。

这项研究由国立神经疾病与卒中研究所的一项基金资助。Kamel医生及其同事披露无相关利益冲突。

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By: SHERRY BOSCHERT, Cardiology News Digital Network

SAN DIEGO – The risk of thrombosis after giving birth remains significantly elevated for 12 weeks after delivery, twice as long as previously thought, an analysis of data on 1.7 million women found.

Dr. Hooman Kamel and his associates analyzed data on 1,687,930 million women admitted to nonfederal acute-care hospitals or emergency departments in California for first-time labor and delivery during 2005-2010, 1,015 of whom had a thrombotic event within 24 weeks after delivery (0.06%). These included strokes (248), MIs (47), and venous thromboemboli (720 cases).

The chance of a clotting event was 11-fold higher than normal in the first 6 weeks after delivery and was doubled when compared with normal in postpartum weeks 7-12, he reported in a press briefing at the International Stroke Conference.

An extra 22 cases/100,000 deliveries occurred in the first 6 weeks postpartum and an extra 3 cases per 100,000 deliveries occurred in weeks 7-12 postpartum.

By 13-18 weeks after delivery, a 40% higher odds of blood clot was not significantly different than with a year later, said Dr. Kamel, a neurologist at Cornell University, N.Y.

The blood clot risk returned to normal levels seen in women who’ve never delivered a baby by 19-24 weeks after delivery.

The New England Journal of Medicine published the findings online (2014 Feb. 13 [doi: 10.1056/NEJMoa1311485]).

The study confirms that thrombosis after delivery is rare and suggests that clinicians may want to take seriously any possible symptoms of stroke beyond the period that’s generally thought of as postpartum: 6 weeks after delivery. Especially in women who have other risk factors for thrombosis, awareness of continued elevated risk in weeks 7-12 could lead to quicker treatment if a blood clot forms, he said in an interview at the meeting, sponsored by the American Heart Association.

Current guidelines call for postpartum blood-thinning therapy in high-risk women who had an elevated stroke risk prior to pregnancy or other risk factors, and it’s unclear whether this should be extended beyond 6 weeks postpartum, Dr. Kamel said. The new findings may prompt research in this direction.

Meanwhile, physicians and women should take seriously any symptoms of possible thrombosis out to 12 weeks after delivery, such as chest pain or pressure, he said.

The study was supported by a grant from the National Institute of Neurological Disorders and Stroke. Dr. Kamel and his colleagues reported having no financial disclosures.