title: Postpartum heparin therapy for patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP) is associated with significant hemorrhagic complications.
abstract: OBJECTIVE
  To compare the outcome of two groups of 16 patients with hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome treated with heparin therapy or treated conservatively in the postpartum period.
  
  
  METHODS
  This is a retrospective cohort study comparing 16 consecutive patients with HELLP syndrome admitted to the ICU at the University of Florence (Italy) after delivery and treated with heparin, to 16 patients with the same disease admitted to the University of Virginia (UVA, USA) and treated with supportive therapy.
  
  
  RESULTS
  Nine patients in the Florence group developed disseminated intravascular coagulation (DIC). Six of them developed postpartum hemorrhage that was medically and surgically controlled. Five hysterectomies were performed and seven other laparotomies were necessary in four patients to control further bleeding complications. In the UVA group, one patient developed DIC and another one a retroperitoneal hematoma that resolved with no need for surgical intervention.
  
  
  CONCLUSIONS
  Heparin therapy for postpartum patients with HELLP syndrome was associated with bleeding complications. We speculate that the heparin therapy was the cause for the bleeding complications occurred in the Florence group of patients.
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Detti
authors.forename: Federico
authors.initials: F
authors.lastname: Mecacci
authors.forename: Anna
authors.initials: A
authors.lastname: Piccioli
authors.forename: Sante
authors.initials: S
authors.lastname: Ferrarello
authors.forename: Lucia
authors.initials: L
authors.lastname: Carignani
authors.forename: Giorgio
authors.initials: G
authors.lastname: Mello
authors.forename: James E
authors.initials: JE
authors.lastname: Ferguson
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Scarselli
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005865:Gestational Age; D017359:HELLP Syndrome / Q000150:complications*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007044:Hysterectomy; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D011644:Puerperal Disorders / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D006493:Heparin