Anticoagulant and antithrombotic drugs in pregnancy: what are the anesthetic implications for labor and cesarean delivery?

Butwick, Alexander J.; Carvalho, Brendan

doi:10.1038/jp.2010.64

Cited by 13 publications

(6 citation statements)

References 90 publications

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“…Regarding prophylactic dosage of aspirin and low‐molecular‐weight heparin, discontinuation before the procedure does not seem justified clinically. However, withholding a single dose of heparin seems advisable.…”

Section: Thromboprophylaxis Before Invasive Proceduresmentioning

confidence: 99%

ISUOG Practice Guidelines: invasive procedures for prenatal diagnosis

Ghi

Sotiriadis

Calda

et al. 2016

Ultrasound Obstet Gynecol

125

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Section: Thromboprophylaxis Before Invasive Proceduresmentioning

confidence: 99%

ISUOG Practice Guidelines: invasive procedures for prenatal diagnosis

Ghi

Sotiriadis

Calda

et al. 2016

Ultrasound Obstet Gynecol

125

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“…The optimal peripartum management of women receiving prophylactic dose LMWH has not been delineated. [6][7][8] Clinical guidelines are in agreement that neuraxial anaesthesia should be allowed if the time elapsed from the last prophylactic LMWH dose exceeds 10-12 hours. 9,[13][14][15][16] However, current recommendations by the ACOG and RCOG do not support or refute planned induction of labour in this context.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 The peripartum management of women treated with LMWH is challenging. [6][7][8] For those on therapeutic dosages *Equal contributors.…”

Section: Introductionmentioning

confidence: 99%

Planned induction versus spontaneous delivery among women using prophylactic anticoagulation therapy: a retrospective study

Rottenstreich

Zacks

Kleinstern

et al. 2020

BJOG

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Objectives To examine the outcomes of planned induction of labour versus spontaneous onset of labour among women using prophylactic‐dose low‐molecular weight heparin (LMWH) therapy. Design Retrospective cohort study. Setting University hospital. Population Women receiving antepartum prophylactic LMWH therapy undergoing a trial of vaginal delivery. Methods Charts from 2018–2019 were reviewed. Main outcome measures Duration of anticoagulation interruption and eligibility to receive neuraxial anaesthesia. Results Data from 199 women were analysed; 78 (39.2%) were admitted following spontaneous onset of labour and 121 (60.8%) underwent planned induction of labour. Compared to women who underwent planned induction of labour, women who presented with spontaneous onset of labour had a shorter median admission‐to‐delivery interval (4.7 versus 29.3 hours, P < 0.001). Similarly, intervals from the last LMWH injection to delivery (25.8 versus 48.2 hours, P < 0.001) and to the first postpartum LMWH injection (41.2 versus 63.7 hours, P < 0.001) were shorter. Among those with spontaneous onset of labour, 69 (88.5%) were eligible to receive neuraxial anaesthesia. Rates of postpartum haemorrhage and blood transfusion were similar between the groups. No thrombotic events were encountered in those with spontaneous onset of labour, but four (3.3%) women who delivered following induction of labour developed a postpartum thrombotic event. Conclusion Planned induction of labour was associated with a higher risk of postpartum thrombotic events than was spontaneous onset of labour (4 of 121 [3.3%] versus 0 of 78 [0%]), presumably due to prolonged duration of anticoagulation interruption, although the difference was not statistically significant. Allowing spontaneous onset of labour was associated with comparable rates of bleeding complications, and only a low proportion (9 of 78, 11.5%) were not eligible to receive neuraxial anaesthesia. Tweetable abstract Planned induction among women using prophylactic LMWH therapy might increase the risk of thromboembolic complications.

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“…91 Platelet counts considered safe for delivery are generally over 50 000/mL for cesarean section, over 20 000/mL for vaginal delivery, over 75 000/mL for epidural anesthesia and 50 000/mL for spinal anesthesia. 92,93 Therefore, vaginal delivery with assisted active phase of labour is probably the best option for pregnant patients with vascular disorders of the liver, with cesarean section being reserved for obstetrical indications.…”

Section: Management Of Labor and Deliverymentioning

confidence: 99%

Pregnancy and Vascular Liver Disease

Bissonnette

Durand

Raucourt

et al. 2015

Journal of Clinical and Experimental Hepatology

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Vascular disorders of the liver frequently affect women of childbearing age. Pregnancy and the postpartum are prothrombotic states. Pregnancy seems to be a trigger for Budd-Chiari syndrome in patients with an underlying prothrombotic disorder. Whether pregnancy is a risk factor for other vascular liver disorders is unknown. In women with a known vascular liver disorder and a desire for pregnancy, stabilisation of the liver disease, including the use of a portal decompressive procedure when indicated, should be reached prior to conception. The presence of esophageal varices should be screened and adequate prophylaxis of bleeding applied in a manner similar to what is recommended for patients with cirrhosis. Most women likely benefit from anticoagulation during pregnancy and the postpartum. Labor and delivery are best managed by a multidisciplinary team with experience in this situation. Assisted vaginal delivery is the preferred mode of delivery. Although the risk of miscarriage and premature birth is heightened, current management of these diseases makes it very likely to see the birth of a live baby when pregnancy reaches 20 weeks of gestation.

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Anticoagulant and antithrombotic drugs in pregnancy: what are the anesthetic implications for labor and cesarean delivery?

Cited by 13 publications

References 90 publications

ISUOG Practice Guidelines: invasive procedures for prenatal diagnosis

ISUOG Practice Guidelines: invasive procedures for prenatal diagnosis

Planned induction versus spontaneous delivery among women using prophylactic anticoagulation therapy: a retrospective study

Pregnancy and Vascular Liver Disease

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