Postpartum heparin therapy for patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP) is associated with significant hemorrhagic complications.
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.
Detti
Laura
L
Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA.
Mecacci
Federico
F
Piccioli
Anna
A
Ferrarello
Sante
S
Carignani
Lucia
L
Mello
Giorgio
G
Ferguson
James E
JE
Scarselli
Gianfranco
G
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
D000925:Anticoagulants; D006493:Heparin