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.
Ivermectin Prophylaxis Used for COVID-19: A Citywide, Prospective, Observational Study of 223,128 Subjects Using Propensity Score Matching
