PMID- 27512428
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20160811
LR  - 20201001
IS  - 1753-495X (Print)
IS  - 1753-4968 (Electronic)
IS  - 1753-495X (Linking)
VI  - 7
IP  - 2
DP  - 2014 Jun
TI  - Haemorrhagic complications of peripartum anticoagulation: A retrospective chart 
      review.
PG  - 77-83
LID - 10.1177/1753495X14520849 [doi]
AB  - BACKGROUND: Women with venous thromboembolism (VTE), thrombophilias or mechanical 
      heart valves may require anticoagulation during pregnancy and postpartum. The 
      incidence of postpartum hemorrhage (PPH) in the literature is 2.9-6%, but the 
      rate while on anticoagulation is not well documented. AIMS: To determine the 
      incidence of haemorrhagic complications associated with the use of peripartum 
      anticoagulation, and the types and risk factors for haemorrhagic complications. 
      METHODS: A retrospective chart review was conducted on women who delivered at an 
      academic teaching hospital and received peripartum anticoagulation between 
      January 2000 and August 2009. Women with known bleeding disorders were excluded. 
      RESULTS: In total, 195 cases were identified with mean age 31.3 years and 
      gestational age of 37.7 weeks. Of these, 49% had a history of VTE, 21% had active 
      VTE in the index pregnancy, and 63% had vaginal delivery. Types of 
      anticoagulation used antepartum were unfractionated heparin (UFH) (43%) and low 
      molecular weight heparin (LMWH) (36%), with 26% receiving therapeutic doses. The 
      rate of haemorrhagic complications was 12.8%, with majority being PPH (80%). 
      Sixty percent of the PPH occurred before reintroduction of anticoagulation 
      postpartum. Use of therapeutic UFH antepartum was associated with increased risk 
      of haemorrhagic complications compared to LMWH (OR 3.08, 95% CI 0.663 - 15.03, 
      p = 0.183). CONCLUSION: The rate of haemorrhagic complications is higher in women 
      on peripartum anticoagulation compared with published incidence in unselected 
      obstetric populations; however, this rate is similar to our institution's 
      reported rates. Our findings inform clinicians about competing risks of 
      thrombotic and haemorrhagic complications in this population.
FAU - Wang, Erica Hz
AU  - Wang EH
AD  - Kelowna General Hospital, Kelowna, Canada.
FAU - Marnoch, Catherine A
AU  - Marnoch CA
AD  - Department of Medicine and Department of Obstetrics and Gynaecology, Waitemata 
      District Health Board, Auckland, New Zealand.
FAU - Khurana, Rshmi
AU  - Khurana R
AD  - Department of Medicine and Department of Obstetrics and Gynecology, Faculty of 
      Medicine and Dentistry, University of Alberta, Edmonton, Canada.
FAU - Sia, Winnie
AU  - Sia W
AD  - Department of Medicine and Department of Obstetrics and Gynecology, Faculty of 
      Medicine and Dentistry, University of Alberta, Edmonton, Canada.
FAU - Yuksel, Nese
AU  - Yuksel N
AD  - Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, 
      Canada.
LA  - eng
PT  - Journal Article
DEP - 20140219
PL  - England
TA  - Obstet Med
JT  - Obstetric medicine
JID - 101464191
PMC - PMC4934953
OTO - NOTNLM
OT  - Anticoagulation
OT  - chart review
OT  - haemorrhagic complications
OT  - peripartum
OT  - pregnancy
OT  - retrospective
EDAT- 2014/06/01 00:00
MHDA- 2014/06/01 00:01
PMCR- 2014/06/01
CRDT- 2016/08/12 06:00
PHST- 2016/08/12 06:00 [entrez]
PHST- 2014/06/01 00:00 [pubmed]
PHST- 2014/06/01 00:01 [medline]
PHST- 2014/06/01 00:00 [pmc-release]
AID - 10.1177_1753495X14520849 [pii]
AID - 10.1177/1753495X14520849 [doi]
PST - ppublish
SO  - Obstet Med. 2014 Jun;7(2):77-83. doi: 10.1177/1753495X14520849. Epub 2014 Feb 19.