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Effect of antithrombin Ⅲ among patients with disseminated intravascular coagulation in obstetrics: a nationwide observational study in Japan
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  • Yudai Iwasaki,
  • Hiroyuki Ohbe,
  • Daisuke Shigemi,
  • Kiyohide Fushimi,
  • Hideo Yasunaga
Yudai Iwasaki
Tohoku University Hospital

Corresponding Author:[email protected]

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Hiroyuki Ohbe
The University of Tokyo
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Daisuke Shigemi
The University of Tokyo
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Kiyohide Fushimi
Tokyo Medical and Dental University Graduate School
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Hideo Yasunaga
The University of Tokyo
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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 therefore aimed to investigate the effect of ATⅢ for DIC patients 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 hospitalization between users and non-users of ATⅢ on the day of delivery. Main Outcome Measures: In-hospital mortality, hysterectomy Results: A total of 9,920 patients were enrolled, including 4,329 patients (44%) who used ATⅢ and 5,511 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 vs. 0.5% in the control group; odds ratio, 0.73; 95% confidence interval, 0.35–1.54). Patients in the ATⅢ group, compared with those in the control group, had a significantly lower proportion of receiving hysterectomy during hospitalization (5.3% vs. 8.7%; difference, -2.9%; 95% confidence interval, -4.2 to -1.6%). Conclusions: The present study did not show mortality-reducing effect of ATIII for patients with DIC in obstetrics. ATⅢ may have clinical benefit in terms of reduction in receiving hysterectomy.
05 Feb 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
08 Feb 2021Submission Checks Completed
08 Feb 2021Assigned to Editor
22 Feb 2021Reviewer(s) Assigned
11 May 2021Review(s) Completed, Editorial Evaluation Pending
02 Jul 2021Editorial Decision: Revise Major
03 Aug 20211st Revision Received
09 Aug 2021Submission Checks Completed
09 Aug 2021Assigned to Editor
09 Aug 2021Review(s) Completed, Editorial Evaluation Pending
12 Sep 2021Editorial Decision: Accept