Peripartum Anesthetic Management of Parturient Receiving Antithrombotics
Mohamed Hamdy Yehia Farahat;
Abstract
Chronic Antithrombotic therapy indications are universal regardless of patient population studied, i.e. Prior venous thromboembolism (VTE), and patients with mechanical prosthetic valve represent the majority of patient population receiving antithrombotic therapy irrespective of clinical environment. Pregnancy related complications in women with antithrombin deficiency or antiphospholipid antibody syndrome (APLAs) and other VTE can be added to the previous indications and represent the main indications for thromboprophylaxis among parturient.
Classically, common therapies for thromboprophylaxis among pregnant females are heparin (either unfractionated and or low molecular weight heparin), vitamin K antagonists and antiplatelets. Recently, newer agents have been introduced into practice including danaporoids, direct thrombin inhibitors and fondaparinux. It should be noted that choice of antithrombotic agent during pregnancy is primarily based upon efficacy of antithrombotic agent to reduce maternal morbidity and mortality risks for associated condition with pregnancy and at the same time possess no or minimal inadvertent fetal and maternal complication.
Unfractionated heparin has been used for decades for many indications during pregnancy. It is a large molecule, so it does not cross the placenta and thus, in contrast to the coumarin derivatives, does not cause teratogenesis or toxic fetal effects. Over the last 10 years LMWHs have become the preferred anticoagulants for treating and preventing thromboembolism in all patients. While comparative data are much less robust in pregnant patients, several series have confirmed the safety and efficacy of LMWHs in pregnancy. LMWHs do not cross the placenta and thus have a fetal safety profile equivalent to that of unfractionated heparin. The use of heparin (UFH or LMWH) during pregnancy can be considered the most frequently antithrombotic agent, since it is devoid of fetal complications and they can only possess potential maternal adverse effects. Maternal adverse effects of anticoagulants are similar to those in nonpregnant subjects and include bleeding, heparin induced thrombocytopenia, heparin associated osteoporosis, bruising, local allergic reactions and pain at site of injection.
Thromboprophylaxis during pregnancy is complex as adequate thromboprophylaxis necessitates proper prevention of thromboembolic manifestations and at the same time be safe to mother and fetus. Moreover changes associated with pregnancy renders use of anticoagulation agents more complex. The choice and dosing of anticoagulation should be primarily tailored according to patient’s indication, risks and associated thromboprophylaxis fetal and maternal complications.
Classically, common therapies for thromboprophylaxis among pregnant females are heparin (either unfractionated and or low molecular weight heparin), vitamin K antagonists and antiplatelets. Recently, newer agents have been introduced into practice including danaporoids, direct thrombin inhibitors and fondaparinux. It should be noted that choice of antithrombotic agent during pregnancy is primarily based upon efficacy of antithrombotic agent to reduce maternal morbidity and mortality risks for associated condition with pregnancy and at the same time possess no or minimal inadvertent fetal and maternal complication.
Unfractionated heparin has been used for decades for many indications during pregnancy. It is a large molecule, so it does not cross the placenta and thus, in contrast to the coumarin derivatives, does not cause teratogenesis or toxic fetal effects. Over the last 10 years LMWHs have become the preferred anticoagulants for treating and preventing thromboembolism in all patients. While comparative data are much less robust in pregnant patients, several series have confirmed the safety and efficacy of LMWHs in pregnancy. LMWHs do not cross the placenta and thus have a fetal safety profile equivalent to that of unfractionated heparin. The use of heparin (UFH or LMWH) during pregnancy can be considered the most frequently antithrombotic agent, since it is devoid of fetal complications and they can only possess potential maternal adverse effects. Maternal adverse effects of anticoagulants are similar to those in nonpregnant subjects and include bleeding, heparin induced thrombocytopenia, heparin associated osteoporosis, bruising, local allergic reactions and pain at site of injection.
Thromboprophylaxis during pregnancy is complex as adequate thromboprophylaxis necessitates proper prevention of thromboembolic manifestations and at the same time be safe to mother and fetus. Moreover changes associated with pregnancy renders use of anticoagulation agents more complex. The choice and dosing of anticoagulation should be primarily tailored according to patient’s indication, risks and associated thromboprophylaxis fetal and maternal complications.
Other data
| Title | Peripartum Anesthetic Management of Parturient Receiving Antithrombotics | Other Titles | المعالجة التخديرية فى ما يخص الأدوية المضادة لتخثر الدم فى فترة ماحول الولادة | Authors | Mohamed Hamdy Yehia Farahat | Issue Date | 2014 |
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