PMID- 18510687
OWN - NLM
STAT- MEDLINE
DCOM- 20090519
LR  - 20090316
IS  - 1365-2141 (Electronic)
IS  - 0007-1048 (Linking)
VI  - 142
IP  - 3
DP  - 2008 Jul
TI  - Audit of the peri-delivery use of unfractionated heparin in women on therapeutic 
      low-molecular weight heparin.
PG  - 453-6
LID - 10.1111/j.1365-2141.2008.07198.x [doi]
AB  - There is no evidence-based approach for the optimal management of peri-delivery 
      anticoagulation in women receiving therapeutic dose of low-molecular weight 
      heparin (LMWH) during pregnancy. Nevertheless, the maintenance of anticoagulation 
      for the maximal period peri-delivery appears appropriate in women considered to 
      be at high risk of venous or arterial thromboembolism. We developed a regimen 
      based on fixed thromboprophylactic dose of unfractionated heparin (UFH) 
      peri-delivery and undertook an audit to evaluate the use and feasibility of this 
      approach and any adverse events. Fixed intravenous thromboprophylactic dose of 
      UFH (15,000 units/24 h) was commenced on the evening prior to a planned delivery 
      [induction of labour or elective caesarean section (CS)], stopped 4 h predelivery 
      and restarted 2-6 h postdelivery. Compliance was good with 32/38 consecutive 
      deliveries managed according to the regimen. There were no cases of postpartum 
      haemorrhage and no thrombosis associated with these 32 deliveries. Twenty-one 
      patients were delivered by CS (11 elective) and eight patients received 
      epidural/spinal anaesthesia without complication. In conclusion, the fixed 
      thromboprophylactic dose UFH regimen provided maintenance of anticoagulation 
      except for a matter of hours without excessive bleeding risk (conducive to 
      neuroaxial anaesthesia) and was simple, flexible and acceptable to staff and 
      patients.
FAU - Lambert, J R
AU  - Lambert JR
AD  - Department of Haematology, Univeristy College London, University College London 
      Hospitals NHS Foundation Trust, London, UK.
FAU - Austin, S K
AU  - Austin SK
FAU - Peebles, D
AU  - Peebles D
FAU - Cohen, H
AU  - Cohen H
LA  - eng
PT  - Journal Article
DEP - 20080524
PL  - England
TA  - Br J Haematol
JT  - British journal of haematology
JID - 0372544
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Anesthesia, Obstetrical
MH  - Anesthesia, Spinal
MH  - Anticoagulants/*therapeutic use
MH  - Cesarean Section
MH  - Female
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/administration & dosage
MH  - Humans
MH  - Incidence
MH  - Labor, Induced
MH  - *Labor, Obstetric
MH  - Medical Audit/*methods
MH  - Patient Compliance
MH  - Postpartum Hemorrhage/prevention & control
MH  - Pregnancy
MH  - Retrospective Studies
MH  - Thromboembolism/*prevention & control
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2008/05/31 09:00
MHDA- 2009/05/20 09:00
CRDT- 2008/05/31 09:00
PHST- 2008/05/31 09:00 [pubmed]
PHST- 2009/05/20 09:00 [medline]
PHST- 2008/05/31 09:00 [entrez]
AID - BJH7198 [pii]
AID - 10.1111/j.1365-2141.2008.07198.x [doi]
PST - ppublish
SO  - Br J Haematol. 2008 Jul;142(3):453-6. doi: 10.1111/j.1365-2141.2008.07198.x. Epub 
      2008 May 24.