Time course of recovery and complications of HELLP syndrome with two different treatments: Heparin or dexamethasone

HELLP syndrome is a severe complication of pregnancy characterized by micro angiopathic hemolytic anemia, hepatic dysfunction and thrombocytopenia. Tho ugh delivery is the ultimate therapeutic option, medical treatments, includ ing the use of heparin or corticosteroids, have been employed in the attemp t to improve maternal prognosis. The aim of this retrospective study was to compare the time course of recovery and the incidence of complications in women with HELLP syndrome receiving either heparin or dexamethasone. Betwee n January 1990 and December 1998, 32 patients with HELLP syndrome were care d for at the Institute of Obstetrics and Gynecology of the University of Fl orence: 20 patients were treated with heparin, administered subcutaneously at a dose of 5000 IU every 12 h, whereas 12 women received dexamethasone, a dministered intravenously at a dose of 10 mg every 12 h. Categorical data w ere evaluated with chi-square and Fisher's exact test; continuous data were analyzed with Mann-Whitney U test; P < .05 was considered significant. In the subgroup treated with heparin the incidence of disseminated intravascul ar coagulation (DIC) (P < .02), the number of patients requiring blood tran sfusion (P<.05) and the length of stay at the Intensive Care Unit (ICU) (P< less than>.04) were significantly increased as compared with the subgroup r eceiving dexamethasone; in this latter subgroup, significantly higher plate let count and hematocrit values, and significantly lower levels of lactate dehydrogenase (LDH) could be documented starting from day 2 after delivery. The results of our investigation suggest that the use of dexamethasone in patients with HELLP syndrome is associated with faster regression and lower incidence of complications in comparison to heparin. (C) 2001 Elsevier Sci ence Ltd. All rights reserved.