title: Reconsidering the switch from low-molecular-weight heparin to unfractionated heparin during pregnancy.
abstract: Venous thromboembolic disease accounts for 9% of all maternal deaths in the United States. In patients at risk for thrombosis, common practice is to start prophylactic doses of low-molecular-weight heparin and transition to unfractionated heparin during the third trimester, with the perception that administration of neuraxial anesthesia will be safer while on unfractionated heparin, as spinal/epidural hematomas have been associated with recent use of low-molecular-weight heparin. In patients receiving prophylactic doses of unfractionated heparin, neuraxial anesthesia may be placed, provided the dose used is 5,000 units twice a day. The American Society of Regional Anesthesia and Pain Medicine guidelines recognize that the safety of neuraxial anesthesia in patients receiving more than 10,000 units per day or more than 2 doses per day is unknown, limiting the theoretical benefit of unfractionated heparin at doses higher than 5,000 units twice a day.
authors: Divisions of Maternal Fetal Medicine and Surgical Critical Care, Departments of Obstetrics and Gynecology and Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, Texas.
authors: L D
authors: LD
authors: Pacheco
authors: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas.
authors: G R
authors: GR
authors: Saade
authors: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas.
authors: M M
authors: MM
authors: Costantine
authors: Department of Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, Texas.
authors: R
authors: R
authors: Vadhera
authors: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas.
authors: G D V
authors: GD
authors: Hankins
mesh_terms: D000773:Anesthesia, Obstetrical / Q000009:adverse effects; D000925:Anticoagulants / Q000627:therapeutic use*; D057915:Drug Substitution; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000209:etiology / Q000517:prevention & control; D006493:Heparin / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control*; D011263:Pregnancy Trimester, Third; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin