2010
DOI: 10.1016/j.ijoa.2009.06.008
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Neuraxial anesthesia in obstetric patients receiving anticoagulant and antithrombotic drugs

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Cited by 34 publications
(15 citation statements)
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“…Pregnancy-related pharmacokinetic changes cause increases in glomerular filtration rate, drug protein binding, volume of distribution and enhanced tissue factor dependent blood coagulation which in turn lead to relative heparin resistance. 20,21 The finding was surprising since the dose of UH used (7500 IU) was higher than that used in the non-obstetric population (typically 5000 IU), a choice based on the increased heparin requirement in pregnancy. 8,22 The current findings complement those of Stirrup et al, 23 who measured anti-factor Xa levels following UH injected subcutaneously at doses of 5000, 7500 and 10 000 IU after CS.…”
Section: Discussionmentioning
confidence: 99%
“…Pregnancy-related pharmacokinetic changes cause increases in glomerular filtration rate, drug protein binding, volume of distribution and enhanced tissue factor dependent blood coagulation which in turn lead to relative heparin resistance. 20,21 The finding was surprising since the dose of UH used (7500 IU) was higher than that used in the non-obstetric population (typically 5000 IU), a choice based on the increased heparin requirement in pregnancy. 8,22 The current findings complement those of Stirrup et al, 23 who measured anti-factor Xa levels following UH injected subcutaneously at doses of 5000, 7500 and 10 000 IU after CS.…”
Section: Discussionmentioning
confidence: 99%
“…Concernant l'accouchement, qu'il s'agisse d'un travail déclenché ou d'une césarienne programmée, sauf cas exceptionnel, une fenêtre thérapeu-tique de 24 heures est réalisée afin de permettre la pratique d'une APM et d'éviter un éventuel sur-risque hémorragique lors de l'accouchement (grade B) [49]. Les recommandations de la Société française d'anesthésie-réanimation de 2006 rejoignent point par point les recommandations internationales [17,58]. Elles préconisent un arrêt du traitement curatif : Pendant cette phase, le monitorage répété du TCA (pour l'HNF) et de l'activité anti-Xa (pour les HBPM) peut s'avérer utile pour s'assurer de l'absence d'une activité anticoagulante résiduelle qui pourrait être antagonisée totalement (HNF) ou partiellement (HBPM) par du sulfate de protamine [53].…”
Section: Patientes Sous Hbpm Ou Sous Hnf à Dose Curativeunclassified
“…In these high doses, LMWH should be discontinued at least 24 hours before regional anesthesia, and not restarted until 24 hours after catheter removal. 42 Discontinuation of anticoagulation for 48 hours or longer is not attractive in the setting of treatment of acute VTE (see "Management of delivery").…”
Section: Anticoagulant Drugs Of Choice In Pregnancy: Maternal Safetymentioning
confidence: 99%