title: Blood loss at the time of surgical abortion up to 14 weeks in anticoagulated patients: a case series.
abstract: OBJECTIVE
  To describe estimated blood loss (EBL) with surgical abortion ≤14 weeks' gestation in anticoagulated patients.
  
  
  METHODS
  We invited 170 clinicians involved in a professional listserv to report cases when they performed a surgical abortion on a patient ≤14 weeks' gestation taking an anticoagulant. Clinicians reported EBL and bleeding-related complications (need for a blood transfusion, additional surgical procedures to treat bleeding). We contacted clinicians 30 days postprocedure to capture postoperative complications.
  
  
  RESULTS
  Clinicians reported 52 cases between February 2011 and October 2013. Thirty percent of patients (16/52) stopped the anticoagulant with adequate time for the effects to abate prior to surgery (6 h for heparin, 24 h for low-molecular-weight heparin, International Normalized Ratio ≤1.7 the day prior to surgery for warfarin), while 69% (36/52) continued the anticoagulant either at therapeutic (25/36) or subtherapeutic (16/36) doses. Seventy-eight percent (28/36) of patients who continued the anticoagulant had an EBL of 50 mL or less compared to 88% (14/16) of those who stopped the anticoagulant with adequate time for its effects to abate (p=.73). Bleeding-related complications occurred in four anticoagulated patients and none of the patients who discontinued anticoagulant therapy.
  
  
  CONCLUSIONS
  Continuation of anticoagulation for planned surgical abortion under 84 days does not appear to be associated with heavy bleeding.
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Honolulu, HI 96826, USA. Electronic address: blissk@hawaii.edu.
authors.forename: Bliss
authors.initials: B
authors.lastname: Kaneshiro
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Honolulu, HI 96826, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Tschann
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jensen
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Bednarek
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Honolulu, HI 96826, USA.
authors.forename: Ronnie
authors.initials: R
authors.lastname: Texeira
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Edelman
mesh_terms: D000028:Abortion, Induced / Q000379:methods*; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D001803:Blood Transfusion; D005260:Female; D005865:Gestational Age; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D013513:Obstetric Surgical Procedures / Q000009:adverse effects*; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D006493:Heparin
keywords: Abortion; Anticoagulation; Bleeding; Heparin; Low molecular weight heparin; Warfarin