title: Anti-coagulation complications in pregnancies with severe pulmonary arterial hypertension.
abstract: BACKGROUND
  Epoprostenol, a potent vasodilator, is the treatment of choice for severe pulmonary arterial hypertension (PAH) in pregnancy. However, its inhibition of platelet aggregation increases the risk of coagulation complications with conjunctive use of anti-coagulants for thromboprophylaxis.
  
  
  METHODS
  Case 1 demonstrates a pregnancy complicated by thrombocytopenia. Case 2 describes a pregnancy with newly diagnosed PAH at 35 weeks who delivered by repeat cesarean delivery complicated by a wound hematoma. Case 3 describes a patient who delivered at 32 weeks. She required extracorporeal membrane oxygenation and a heart-lung transplant. Her care was further complicated by severe thrombocytopenia with postpartum hemorrhage refractory to usual conservative measures.
  
  
  CONCLUSIONS
  This case series describes three patients with severe PAH in pregnancy and the range of different complications that arose from anticoagulation in the setting of epoprostenol.
authors.affiliation: a Department of Reproductive Medicine/Division of Perinatal Medicine , University of California , San Diego , CA , USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Herrero
authors.affiliation: b Department of Anesthesiology , University of California , San Diego , CA , USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Martin
authors.affiliation: c Department of Pulmonary Critical Care , University of California , San Diego , CA , USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Poch
authors.affiliation: a Department of Reproductive Medicine/Division of Perinatal Medicine , University of California , San Diego , CA , USA.
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Roeder
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D002585:Cesarean Section / Q000009:adverse effects; D011464:Epoprostenol / Q000009:adverse effects* / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005865:Gestational Age; D016041:Heart-Lung Transplantation; D006406:Hematoma / Q000150:complications; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000188:drug therapy* / Q000601:surgery; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000209:etiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy*; D011256:Pregnancy Outcome; D000072836:Surgical Wound / Q000150:complications; D013921:Thrombocytopenia / Q000139:chemically induced / Q000150:complications
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D011464:Epoprostenol
keywords: Pregnancy; anti-coagulation; pulmonary hypertension; thrombocytopenia; thromboprophylaxis