Effect of antithrombin III among patients with disseminated intravascular coagulation in obstetrics: a nationwide observational study in Japan

Abstract

Objective Pregnant women may develop disseminated intravascular coagulation (DIC), possibly resulting in massive maternal haemorrhage and perinatal death. The Japan guideline recommends use of antithrombin III (ATIII) for DIC in obstetrics; however, its effect remains uncertain. The present study aimed to investigate the effect of ATIII for DIC in obstetrics, using a national inpatient database in Japan. Design Nationwide observational study. Setting Japan. Population We used the Diagnosis Procedure Combination inpatient database to identify patients who delivered at hospital and were diagnosed with DIC from July 2010 to March 2018. Methods Propensity score matching analyses were performed to compare in‐hospital maternal mortality and hysterectomy during hospitalisation between users and non‐users of ATIII on the day of delivery. Main outcome measures In‐hospital mortality, hysterectomy. Results A total of 9920 patients were enrolled, including 4329 patients (44%) who used ATIII and 5511 patients (56%) who did not use ATIII. One‐to‐one propensity score matching created 3290 pairs. In‐hospital maternal mortality did not differ significantly between the propensity‐matched groups (0.3% in the ATIII group versus 0.5% in the control group; odds ratio 0.73; 95% CI 0.35–1.54). A significantly lower proportion of patients in the ATIII group, compared with those in the control group, underwent hysterectomy during hospitalisation (5.3% versus 8.7%; absolute risk difference −2.9%; 95% CI −4.2 to −1.6%). Conclusions Although the present study did not show a mortality‐reducing effect of ATIII for patients with DIC in obstetrics, it may have clinical benefit in terms of reducing the number of patients undergoing hysterectomy. Tweetable abstract This study did not show mortality‐reducing effect of antithrombin III for patients with DIC in obstetrics.

Resuscitative endovascular balloon occlusion of the aorta for life-threatening postpartum hemorrhage: A nationwide observational study in Japan

“…Postpartum hemorrhage patients were defined as those with the following diagnoses: intrapartum hemorrhage ( ICD-10 codes, O679), disseminated intravascular coagulation after labor (O723), shock during labor (O751) or hemorrhage shock (R571), or patients who received blood transfusions. Postpartum hemorrhage patients who underwent cesarean delivery, and other delivery-related procedures were defined as patients who delivered during hospitalization 14 . We excluded patients with primary diagnoses of placenta previa (O441) or placenta accrete spectrum disorders (O720, O722, O730, and O731) because it was unclear whether REBOA was used for prophylactic or therapeutic intervention.…”

“…The database includes the following variables for each patient: sex; age; diagnoses, comorbidities at admission, and complications after admission recorded according to the International Classification of Diseases, Tenth Revision (ICD-10), codes and written in Japanese text; procedures recorded according to the Japanese medical procedure status and code (Supplemental Digital Content, Supplementary Table 2, http://links.lww.com/TA/ C518); drugs used; device code (Supplemental Digital Content, Supplementary Table 2, http://links.lww.com/TA/C518); referral from other facilities; teaching hospital; intensive care unit admission; pregnancy status (pregnant or not); gestational age at admission and delivery during hospitalization; readmitted within 1 week after delivery; date of admission, procedure, and discharge; and discharge status (in-hospital mortality, transportation to other hospital, or discharge to home). 14 Validation of various diagnostic records in this database was conducted to a high standard. 15,16 The sensitivity and specificity of the primary diagnoses were 78.9% and 93.2%, respectively.…”

“…Postpartum hemorrhage patients who underwent cesarean delivery, and other delivery-related procedures were defined as patients who delivered during hospitalization. 14 We excluded patients with primary diagnoses of placenta previa (O441) or placenta accrete spectrum disorders (O720, O722, O730, and O731) because it was unclear whether REBOA was used for prophylactic or therapeutic intervention. Patients who did not undergo REBOA and who underwent REBOA for trauma were excluded from this study.…”

Exploring the epidemiology of disseminated intravascular coagulation: protocol for the DANish Disseminated Intravascular Coagulation (DANDIC) Cohort Study

“…3 4 Moreover, most existing studies did not have population-based case ascertainment covering multiple DIC aetiologies. 6 Prior studies that relied on diagnosis codes from administrative registries to identify patients with DIC 5 did not capture mild, subclinical and transient DIC episodes, and thus were unable to account for disease severity in their analyses. Currently, only a few DIC registries and other data sources exist.…”

“…Despite the devastating prognosis of DIC, specific knowledge about its epidemiology remains limited. The few studies that have investigated the clinical epidemiology of DIC have been limited to selected patients, for example, patients in the intensive care unit (ICU) at university hospitals3 4; were mainly conducted in Japan3 5; were more than 10 years old3 4; were unable to track patients across transitions in sites of care, for example, transfer between hospitals4 6; and did not include rich clinical data on symptoms/signs, laboratory records, microbiology and in-hospital treatment, for example, transfusions or use of haemostatic drugs 3 4. Moreover, most existing studies did not have population-based case ascertainment covering multiple DIC aetiologies 6.…”