Objective. Drip infusion during long-term tocolysis causes mechanical and infectious vasculitis and increases the frequency of peripheral venous catheter exchange (PVC), thereby placing a burden on patients. Our study aim is to confirm whether heparin ameliorates pain due to vasculitis during long-term tocolysis and reduces the frequency of peripheral venous catheter exchange. Design. Prospective study. Setting and Sample. All the patients requiring admission because of the presence of uterine contraction or progressive cervical dilatation from August 2009 to June 2011 at Juntendo University in Japan. Methods. Heparin was used for patients at the time the total number of peripheral venous catheter exchanges exceeded 5 in two weeks, and we evaluated whether heparin reduced the frequency of peripheral venous catheter exchange and improved the visual analog scale (VAS) for patients. The main outcome measures frequency of PVC exchange and VAS. Results. This study demonstrated that heparin reduced the frequency of peripheral venous catheter exchange ( ) and VAS ( ). No side effects were noted. Conclusion. Heparin could satisfy patients during long-term tocolysis in terms of ameliorating pain due to vasculitis and reducing the PVC exchange frequency. 1. Introduction Preterm labor is considered differently in Japan and USA. Continuous tocolysis for more than 48 hours is not recommended in the USA. But in Japan Ritodrine hydrochloride is usually used for long-term tocolysis under the presence of uterine contraction or progressive cervical dilatation. This therapy leads to the lower premature delivery rate in Japan (actually 5.7% in 2007) than the other country (10.6% in north America). But drip infusion therapy during long term tocolysis causes pain due to vasculitis, and the PVC must be exchanged often. Three kinds of vasculitis mechanism have recently been proposed [1]. One is chemical, another is mechanical, and the third is bacterial vasculitis. Chemical vasculitis is caused by hypertonic infusion. The pH discrepancy between the infusion and inside blood vessels is also a cause of vasculitis. The peripheral venous catheter itself also causes vasculitis by injuring endothelial cells, a form of mechanical vasculitis. Infection with bacteria also causes vasculitis. These three elements can combine to exacerbate vasculitis during long term tocolysis. These elements are thought to be prevented by heparin’s anti-inflammatory [2], anticoagulant [3, 4], and cell migration effects. Heparin’s anti-coagulant effect can improve blood flow. Furthermore, cell migration
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