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.
Lambert
J R
JR
Department of Haematology, Univeristy College London, University College London Hospitals NHS Foundation Trust, London, UK.
Austin
S K
SK
Peebles
D
D
Cohen
H
H
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