PMID- 35020621
OWN - NLM
STAT- MEDLINE
DCOM- 20220419
LR  - 20230721
IS  - 1526-7598 (Electronic)
IS  - 0003-2999 (Linking)
VI  - 134
IP  - 5
DP  - 2022 May 1
TI  - Varying Dosages of Subcutaneous Unfractionated Heparin and Activated Partial 
      Thromboplastin Time in Hospitalized Antepartum Patients: A Retrospective Cohort 
      Analysis.
PG  - 1028-1034
LID - 10.1213/ANE.0000000000005866 [doi]
AB  - BACKGROUND: Venous thromboembolism (VTE) is a leading cause of maternal morbidity 
      and mortality in the United States. Subcutanous unfractionated heparin (UFH) has 
      been used for decades for VTE prophylaxis and under many obstetric quality of 
      care initiatives, hospitalized antepartum patients now receive doses as high as 
      10,000 units every 12 hours. This practice increases the likelihood of UFH 
      administration around the time that epidural labor analgesia is requested or 
      neuraxial analgesia for cesarean delivery is needed. To clarify the effect of UFH 
      on coagulation, we reviewed the care of hospitalized antepartum patients 
      receiving VTE prophylaxis with UFH to determine the incidence of concurrent 
      abnormal activated partial thromboplastin time (aPTT) values and associated risk 
      factors. METHODS: This retrospective cohort study used data from the University 
      of Chicago Pharmacy database to identify hospitalized antepartum patients 
      receiving subcutaneous UFH from June 1, 2016 to July 1, 2019. Our institutional 
      protocol states that all patients hospitalized for antepartum conditions should 
      receive pharmacologic prophylaxis empirically unless contraindicated. For 
      patients receiving UFH, dosing was based on gestational age: 5000 units every 12 
      hours for first trimester antepartum patients, 7500 units every 12 hours for 
      second trimester patients, and 10,000 units every 12 hours for patients in the 
      third trimester. As per protocol, aPTT values were obtained 2 hours after the 
      third dose of heparin, and platelet counts after 4 days. Data collection included 
      demographics, comorbidities, heparin doses, aPTT values, platelet counts, 
      creatinine if available, and anesthetic type and complications. Logistic 
      regression was performed to determine the association between elevated aPTT >40 
      seconds and study variables. RESULTS: Of the 321 antepartum patients who received 
      subcutaneous UFH, 33 (10.3%) had an aPTT >40 seconds, 4 of those 33 patients 
      (12.1%) received 5000 units every 12 hours, 14 (42.2%) received 7500 units every 
      12 hours, and 15 (45.5%) received 10,000 units every 12 hours. The likelihood of 
      a patient having aPTT >40 seconds was 2.8% with 5000 units every 12 hours, 18.9% 
      with 7500 units every 12 hours, and 14.6% with 10,000 units every 12 hours. 
      CONCLUSIONS: Elevated aPTT values are likely with total daily doses of 15,000 or 
      20,000 units subcutaneous UFH in hospitalized antepartum patients.
CI  - Copyright (c) 2022 International Anesthesia Research Society.
FAU - Elmofty, Dalia H
AU  - Elmofty DH
AD  - From the Department of Anesthesia and Critical Care, University of Chicago, 
      Chicago, Illinois.
FAU - Tucker, Andrew
AU  - Tucker A
AD  - Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
FAU - Wuenstel, Andrew M
AU  - Wuenstel AM
AD  - From the Department of Anesthesia and Critical Care, University of Chicago, 
      Chicago, Illinois.
FAU - Cheng, Paul K
AU  - Cheng PK
AD  - From the Department of Anesthesia and Critical Care, University of Chicago, 
      Chicago, Illinois.
FAU - Fox, Edward
AU  - Fox E
AD  - From the Department of Anesthesia and Critical Care, University of Chicago, 
      Chicago, Illinois.
FAU - Knoebel, Randall
AU  - Knoebel R
AD  - Departments of Pharmacy.
FAU - Liao, Chuanghong
AU  - Liao C
AD  - Public Health Sciences.
FAU - Scavone, Barbara
AU  - Scavone B
AD  - From the Department of Anesthesia and Critical Care, University of Chicago, 
      Chicago, Illinois.
AD  - Obstetrics and Gynecology, University of Chicago, Chicago, Illinois.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Anesth Analg
JT  - Anesthesia and analgesia
JID - 1310650
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants
MH  - *Blood Coagulation Disorders/drug therapy
MH  - Cohort Studies
MH  - Female
MH  - Heparin
MH  - Humans
MH  - Partial Thromboplastin Time
MH  - Pregnancy
MH  - Retrospective Studies
MH  - *Venous Thromboembolism/diagnosis/epidemiology/prevention & control
COIS- The authors declare no conflicts of interest.
EDAT- 2022/01/13 06:00
MHDA- 2022/04/20 06:00
CRDT- 2022/01/12 17:23
PHST- 2022/01/13 06:00 [pubmed]
PHST- 2022/04/20 06:00 [medline]
PHST- 2022/01/12 17:23 [entrez]
AID - 00000539-202205000-00020 [pii]
AID - 10.1213/ANE.0000000000005866 [doi]
PST - ppublish
SO  - Anesth Analg. 2022 May 1;134(5):1028-1034. doi: 10.1213/ANE.0000000000005866.