title: Postpartum wound and bleeding complications in women who received peripartum anticoagulation.
abstract: BACKGROUND
  The objective of this study was to compare wound and bleeding complications between women who received anticoagulation after cesarean delivery due to history of prior venous thromboembolic disease, arterial disease, or being a thrombophilia carrier with adverse pregnancy outcome, to women not receiving anticoagulation.
  
  
  METHODS
  Women in the Duke Thrombosis Center Registry who underwent cesarean delivery during 2003-2011 and received postpartum anticoagulation (anticoagulation group, n=77), were compared with a subset of women who delivered during the same time period, but did not receive anticoagulation (no anticoagulation group, n=77). The no anticoagulation group comprised women who were matched to the anticoagulation group by age, body mass index, type of cesarean (no labor vs. labor), and date of delivery. Bleeding and wound complications were compared between the two groups. A multivariable logistic regression model was constructed to determine if anticoagulation was an independent predictor of wound complication.
  
  
  RESULTS
  Women who received anticoagulation during pregnancy had a greater incidence of wound complications compared to those who did not (30% vs. 8%, p<0.001). Using multivariable logistic regression, while controlling for race, diabetes, chorioamnionitis, and aspirin use, anticoagulation predicted the development of any wound complication (OR 5.8, 95% CI 2.2, 17.6), but there were no differences in the mean estimated blood loss at delivery (782 vs. 778 ml, p=0.91), change in postpartum hematocrit (5.4 vs. 5.2%, p=0.772), or percent of women receiving blood products (6.5 vs. 1.3%, p=0.209) between the two groups.
  
  
  CONCLUSIONS
  Anticoagulation following cesarean delivery is associated with an increased risk of post-cesarean wound complications, but not other postpartum bleeding complications.
authors.affiliation: Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Limmer
authors.forename: Chad A
authors.initials: CA
authors.lastname: Grotegut
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Thames
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Dotters-Katz
authors.forename: Leo R
authors.initials: LR
authors.lastname: Brancazio
authors.forename: Andra H
authors.initials: AH
authors.lastname: James
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D058725:Peripartum Period; D006473:Postpartum Hemorrhage / Q000139:chemically induced*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced*; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000139:chemically induced*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; BMI; CDC; Centers for Disease Control and Prevention; DVT; LMWH; OR; PE; Pregnancy; UFH; Wound complications; body mass index; deep vein thrombosis; low molecular weight heparin; odds ration; pulmonary embolism; unfractionated heparin