Audit of the peri-delivery use of unfractionated heparin in women on therapeutic low-molecular weight heparin.
There is no evidence-based approach for the optimal management of peri-delivery anticoagulation in women receiving therapeutic dose of low-molecular weight heparin (LMWH) during pregnancy. Nevertheless, the maintenance of anticoagulation for the maximal period peri-delivery appears appropriate in women considered to be at high risk of venous or arterial thromboembolism. We developed a regimen based on fixed thromboprophylactic dose of unfractionated heparin (UFH) peri-delivery and undertook an audit to evaluate the use and feasibility of this approach and any adverse events. Fixed intravenous thromboprophylactic dose of UFH (15,000 units/24 h) was commenced on the evening prior to a planned delivery [induction of labour or elective caesarean section (CS)], stopped 4 h predelivery and restarted 2-6 h postdelivery. Compliance was good with 32/38 consecutive deliveries managed according to the regimen. There were no cases of postpartum haemorrhage and no thrombosis associated with these 32 deliveries. Twenty-one patients were delivered by CS (11 elective) and eight patients received epidural/spinal anaesthesia without complication. In conclusion, the fixed thromboprophylactic dose UFH regimen provided maintenance of anticoagulation except for a matter of hours without excessive bleeding risk (conducive to neuroaxial anaesthesia) and was simple, flexible and acceptable to staff and patients.
Department of Haematology, Univeristy College London, University College London Hospitals NHS Foundation Trust, London, UK.
J R
JR
Lambert
S K
SK
Austin
D
D
Peebles
H
H
Cohen
D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D000925:Anticoagulants / Q000627:therapeutic use*; D002585:Cesarean Section; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007751:Labor, Induced; D007743:Labor, Obstetric; D008485:Medical Audit / Q000379:methods*; D010349:Patient Compliance; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D011247:Pregnancy; D012189:Retrospective Studies; D013923:Thromboembolism / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin