Haematological interventions for treating disseminated intravascular coagulation during pregnancy and postpartum


Evidence from randomised controlled trials (RCTs) to establish the beneficial and harmful effects of drugs altering blood clotting for treating disseminated intravascular coagulation (DIC) in pregnant women and following birth is lacking.

DIC is characterised by widespread blood clotting (coagulation) in the blood vessels. It is an emergency in pregnant women as it can lead to organ dysfunction and bleeding because of depletion of platelets and coagulation factors with the ongoing activation of blood clotting (deposition of fibrin). Obstetric causes include complications such as amniotic fluid embolism, pre-eclampsia and eclampsia, HELLP syndrome (haemolysis, elevated liver enzymes and low platelets), placental abruption and placenta praevia, intrauterine infection and death of the fetus.

DIC must be managed by treating the underlying disease, which may require surgical and nonsurgical interventions, antibiotic therapy, replacement of blood products, fluid therapy and uterine evacuation. Supportive anticoagulant drugs are given to resolve coagulation abnormalities. These include heparin or low molecular weight heparin (LMWH), danaparoid sodium, synthetic protease inhibitor, antithrombin, human recombinant activated protein C, recombinant activated factor VIIa, recombinant human soluble thrombomodulin, and recombinant tissue factor pathway inhibitor.

The review authors searched the medical literature for RCTs in which haematological approaches were compared for their efficacy and safety in pregnant women and immediately after birth but could not find any  trials.

 

Authors' conclusions: 

This review found no RCTs on the safety and efficacy of haematological interventions for treating DIC during pregnancy and postpartum. Such interventions need to be tested in RCTs assessing outcomes such as maternal death, perinatal death and safety.

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Background: 

Disseminated intravascular coagulation (DIC) is an acquired syndrome characterised by systemic intravascular activation of coagulation. There are several obstetric causes of DIC during pregnancy and postpartum.

Objectives: 

To assess the clinical effectiveness and safety of haematological interventions such as heparins (low molecular weight heparin (LMWH) and unfractionated heparin (UFH), danaparoid sodium, synthetic protease inhibitor, antithrombin, human recombinant activated protein C, recombinant human soluble thrombomodulin, recombinant tissue factor pathway inhibitor, recombinant activated factor VIIa and any other types of haematological interventions (except transfusions) for treating DIC during pregnancy and postpartum.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 July 2010), LILACS (1982 to 22 July 2010), ongoing trials registries via the World Health Organization International Clinical Trials Platform Search Portal (22 July 2010), and other relevant websites (22 July 2010).

Selection criteria: 

Randomised controlled trials (RCTs) on any haematological interventions for treating DIC during pregnancy and postpartum.

Data collection and analysis: 

There were no included studies.

Main results: 

We could not find any RCTs on haematological interventions (heparins (LMWH and UFH), danaparoid sodium, synthetic protease inhibitor, antithrombin, human recombinant activated protein C, recombinant human soluble thrombomodulin, recombinant tissue factor pathway inhibitor, recombinant activated factor VIIa and any other types of haematological interventions) for treating DIC during pregnancy and postpartum.

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