title: Prolonged activated partial thromboplastin time in thromboprophylaxis with unfractionated heparin in patients undergoing cesarean section.
abstract: OBJECTIVE
  Hemorrhage is an important complication of heparin-thromboprophylaxis after surgery. We attempted to clarify the incidence rate of prolonged activated partial thromboplastin time (APTT), representative of hemorrhagic tendency, in Japanese women who received thromboprophylaxis with unfractionated subcutaneous heparin administration after cesarean section (CS). We also determined factors which affected postoperative APTT.
  
  
  METHODS
  We studied 280 women who were administered thromboprophylaxis with unfractionated subcutaneous heparin 5000 IU two times per day after CS. Postoperative APTT under heparin was measured and the incidence of its prolongation was determined. Preoperative APTT, blood loss during surgery, postoperative hematocrit, postoperative serum total protein level, and postpartum body weight were measured, and their correlation with postoperative APTT was determined.
  
  
  RESULTS
  Preoperative and postoperative APTT values were 28.3 (26.7-30.3) and 33.8 (31.0-37.5) seconds for median (interquartile range), respectively. Overall, 7.1% of patients showed >or=45 s postoperative APTT. Two patients (0.7%) showed >or=60 s APTT, one of whom suffered subcutaneous hemorrhage around the abdominal incision with complete healing. There were no other hemorrhagic complications. Preoperative APTT positively, and postpartum body weight inversely, correlated with postoperative APTT. The amount of blood loss, postoperative hematocrit, and postoperative serum total protein level did not correlate with postoperative APTT. No discernible deep vein thrombosis or pulmonary embolism occurred.
  
  
  CONCLUSIONS
  Although 7.1% of women under heparin-thromboprophylaxis showed a prolonged APTT that was 150% of the preoperative APTT, serious side effects were not observed. Subcutaneous administration of unfractionated heparin, if checking APTT prolongation 1 day after surgery, may be safe method of thromboprophylaxis after CS.
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan. matsushi@jichi.ac.jp
authors.forename: Shigeki
authors.initials: S
authors.lastname: Matsubara
authors.forename: Rie
authors.initials: R
authors.lastname: Usui
authors.forename: Akihide
authors.initials: A
authors.lastname: Ohkuchi
authors.forename: Satsuki
authors.initials: S
authors.lastname: Okuno
authors.forename: Akio
authors.initials: A
authors.lastname: Izumi
authors.forename: Takashi
authors.initials: T
authors.lastname: Watanabe
authors.forename: Norimasa
authors.initials: N
authors.lastname: Seo
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Suzuki
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D002585:Cesarean Section; D016903:Drug Monitoring; D005260:Female; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007564:Japan / Q000453:epidemiology; D010314:Partial Thromboplastin Time; D011183:Postoperative Complications / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors; D013927:Thrombosis / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006493:Heparin