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Am J Perinatol. 2014 Sep;31(8):655-8. doi: 10.1055/s-0033-1359719. Epub 2013 Dec 11.

Reconsidering the switch from low-molecular-weight heparin to unfractionated heparin during pregnancy.

Author information

  • 1Divisions of Maternal Fetal Medicine and Surgical Critical Care, Departments of Obstetrics and Gynecology and Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, Texas.
  • 2Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas.
  • 3Department of Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, Texas.

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.

PMID:
24338124
DOI:
10.1055/s-0033-1359719
[PubMed - indexed for MEDLINE]
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