Abstract Number: PB1298
Meeting: ISTH 2021 Congress
Background: Low molecular weight heparin (LMWH) is the most frequently used drug in pregnancy for prophylaxis or treatment of thromboembolic disease or obstetric complications. Delivery timing is challenging both preventing bleeding and also thrombosis. Intermediate or high doses could be associated with an increased risk of peripartum bleeding. Expert recommendations range from education, programmed suspension, dose reduction, or induction of labor.
Aims: To describe the heparin peripartum management and its association with hemorrhagic and/ or thrombotic complications in our population.
Methods: Retrospective multicenter study to analyze the peripartum management of LMWH-treatment pregnant women between 2004 to 2020. Data were analyzed by Chi (2).
Results: 499 pregnancies in 448 women were included (Table 1). Median age: 35 years (19-50).
28/ 499 programmed labor induction, and 22/ 28 (79%) were successful.
Prepartum hemorrhage was presented in 14/499 pregnancies (2.8%), but there was no significant (NS) correlation with the dose of heparin
No patients presented spinal hematoma.
19/ 499 (3,8 %) presented postpartum hemorrhage. 6/19 had major bleeding according ISTH SSC.
There was NS association between bleeding and last heparin dose: urgent cesarean section (< 12 hrs last heparin dose), patient education group (12 – 24 hrs last heparin dose) or programmed suspension (>24 hrs to ≥ 1 week).
Also there was NS association between heparin dose (prophylactic, intermediate or therapeutic) and bleeding.
There was only one event of thrombotic complication (superficial venous thrombosis).
| Table 1- CLINICAL CHARACTERISTICS | |
| Pregnancies n 499 | N (%) |
| LMWH indication Obstetric Infertility Hematologic Hematologic + Obstetric |
499 344 (68) 98 (19.6) 55 (11.02) 2 (0.4) |
| LMWH doses Prophylactic* Intermediate Therapeutic** |
499 338 (67.7) 147 (29.4) 14 (2.8) |
| LMWH antepartum suspension <12 hours 12-24 hours >24 hours – 6 days ≥ 1 week |
499 10 (2) 395 (79.15) 77 (15.43) 17 (3.4) |
| Delivery Mode and Anesthesia Vaginal delivery Labor epidural analgesia Caesarean section Neuroaxial anesthesia General anesthesia |
499 129 (25.85) 107/129 (83) 370 (74.15) 367/370 (99.2) 3/370 (0.8) |
| Cesarean section indication Obstetric Elective Not specified |
370 174 (47.02) 133 (35.95) 63 (17.03) |
Conclusions: We did not find any significant association between heparin dose or the time from last dose to delivery and bleeding or thrombotic complications.
There was a high rate of elective caesarean sections.
The education of the pregnant woman for the optimal time to hold heparin prior to delivery is a safe method without significantly increasing the risk of hemorrhagic or thrombotic complications.
To cite this abstract in AMA style:
Molnar S, Gumpel C. Pregnancy and Heparin: Peripartum Management. Experience of Two Centers in Argentina [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/pregnancy-and-heparin-peripartum-management-experience-of-two-centers-in-argentina/. Accessed September 24, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/pregnancy-and-heparin-peripartum-management-experience-of-two-centers-in-argentina/