title: [Anticoagulation and peripartum management].
abstract: OBJECTIVE
  To compare peripartum management of anticoagulated patients concerning locoregional analgesia, post-partum hemorrhage and thrombotic events according to planified interruption or not of antithrombotic therapy.
  
  
  METHODS
  We conducted a single tertiary care center retrospective study of all deliveries associated with antithrombotic therapy from January 2005 to September 2011.
  
  
  RESULTS
  We identified 120 cases with prophylactic (71%) or curative (29%) anticoagulation. Two thrombotic events occurred. In case of curative therapy, the use of locoregional analgesia was lower (P<0.0001) and post-partum hemorrhage occurred more frequently (P=0.07) compared to prophylactic therapy. According to planified interruption or not of antithrombotic therapy, we observed a more prolonged duration of therapeutic interruption before delivery (55.6h±63.3 vs 26.4 h±11.6, P<0.0001), higher use of locoregional analgesia (83% vs 71%, P=0.02) but no difference concerning cesarean rate (35% vs 39%, P=0.8) or post-partum hemorrhage (13% vs 14%, P=0.9).
  
  
  CONCLUSIONS
  In case of curative anticoagulation, plannified interruption favours the use of perimedullar analgesia after 24hour delay. In case of preventive anticoagulation, plannified interruption appears unnecessary as the 12hour delay is easier to reach.
authors.affiliation: Pôle gynéco-obstétrique-reproduction humaine, CHU Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: A
authors.initials: A
authors.lastname: Philippe
authors.affiliation: Pôle des spécialités médicales, médecine interne, CHU Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: M
authors.initials: M
authors.lastname: Ruivard
authors.affiliation: Département de biostatistiques, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Auclair
authors.affiliation: Pôle gynéco-obstétrique-reproduction humaine, CHU Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: M
authors.initials: M
authors.lastname: Accoceberry
authors.affiliation: Pôle des ressources interventionnelles, anesthésie-réanimation, CHU Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: M
authors.initials: M
authors.lastname: Bonnin
authors.affiliation: Pôle gynéco-obstétrique-reproduction humaine, CHU Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Pouly
authors.affiliation: Pôle gynéco-obstétrique-reproduction humaine, CHU Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: D
authors.initials: D
authors.lastname: Lémery
authors.affiliation: Pôle des spécialités médicales, médecine interne, CHU Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: P
authors.initials: P
authors.lastname: Philippe
authors.affiliation: Pôle gynéco-obstétrique-reproduction humaine, CHU Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; R2D2-EA7281, faculté de médecine, université d'Auvergne, place Henri-Dunant, 63000 Clermont-Ferrand, France. Electronic address: dgallot@chu-clermontferrand.fr.
authors.forename: D
authors.initials: D
authors.lastname: Gallot
mesh_terms: D000328:Adult; D000698:Analgesia / Q000706:statistics & numerical data; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D058725:Peripartum Period; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies; D062606:Tertiary Care Centers
chemical_list: D000925:Anticoagulants
keywords: Accouchement; Analgésie périmédullaire; Anticoagulation; Complication thromboembolique; Delivery; Hémorragie du post-partum; Locoregional analgesia; Peripartum; Post-partum hemorrhage; Péri-partum; Thromboembolic event