Evidence from randomised controlled trials (RCTs) to establish the beneficial and harmful effects of drugs altering blood clotting for treating disseminated intravascular coagulation (DIC) in pregnant women and following birth is lacking.
DIC is characterised by widespread blood clotting (coagulation) in the blood vessels. It is an emergency in pregnant women as it can lead to organ dysfunction and bleeding because of depletion of platelets and coagulation factors with the ongoing activation of blood clotting (deposition of fibrin). Obstetric causes include complications such as amniotic fluid embolism, pre-eclampsia and eclampsia, HELLP syndrome (haemolysis, elevated liver enzymes and low platelets), placental abruption and placenta praevia, intrauterine infection and death of the fetus.
DIC must be managed by treating the underlying disease, which may require surgical and nonsurgical interventions, antibiotic therapy, replacement of blood products, fluid therapy and uterine evacuation. Supportive anticoagulant drugs are given to resolve coagulation abnormalities. These include heparin or low molecular weight heparin (LMWH), danaparoid sodium, synthetic protease inhibitor, antithrombin, human recombinant activated protein C, recombinant activated factor VIIa, recombinant human soluble thrombomodulin, and recombinant tissue factor pathway inhibitor.
The review authors searched the medical literature for RCTs in which haematological approaches were compared for their efficacy and safety in pregnant women and immediately after birth but could not find any trials.