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

Luis Pacheco, George Saade, Maged Costantine, Rakesh Vadhera, Gary Hankins

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)655-658
Number of pages4
JournalAmerican Journal of Perinatology
Volume31
Issue number8
DOIs
StatePublished - 2014

Fingerprint

Low Molecular Weight Heparin
Heparin
Pregnancy
Anesthesia
Spinal Epidural Hematoma
Maternal Death
Third Pregnancy Trimester
Thrombosis
Guidelines
Safety

Keywords

  • low-molecular-weight heparin
  • neuraxial anesthesia
  • unfractionated heparin

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Reconsidering the switch from low-molecular-weight heparin to unfractionated heparin during pregnancy. / Pacheco, Luis; Saade, George; Costantine, Maged; Vadhera, Rakesh; Hankins, Gary.

In: American Journal of Perinatology, Vol. 31, No. 8, 2014, p. 655-658.

Research output: Contribution to journalArticle

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