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A Nationwide Survey of Neuraxial Anesthesia Practices in Parturients Receiving Systemic Anticoagulation
Abstract Number: F-22
Abstract Type: Original Research
Introduction: The 2016 Council on Patient Safety in Women’s Health Care Venous Thromboembolism bundle will result in more prevalent use of anticoagulation in parturients (1). This practice change may restrict use or complicate timing of neuraxial anesthesia. ASRA anticoagulation guidelines do not address some commonly used anticoagulation regimens in pregnancy. We sought to define academic institutional practices for neuraxial anesthesia in anticoagulated parturients. We hypothesized that >75% of units would have obstetric-specific guidelines for administration of neuraxial anesthesia in anticoagulated parturients.
Methods: A survey was developed by an expert panel. Inquiry domains included hospital characteristics, institutional guidelines and management practices using 5 clinical vignettes. The anesthetic recommendations for one vignette (prophylactic heparin, 5000 U SQ BID) were defined in the 2010 ASRA guidelines. 4 other vignettes presented commonly used anticoagulation regimens or clinical scenarios without clear recommendations for parturients. 103 obstetric anesthesia directors identified in the SOAP registry were surveyed by email. Univariate statistics were used to characterize responses.
Results: The survey response rate was 55%. 32% of responding units (95% [CI]: 19.1–44.0%) reported having a formal protocol to guide neuraxial anesthesia management in anticoagulated parturients, which was less than we hypothesized (P<0.005). 66% of respondents indicated that they do not delay initiation of neuraxial analgesia in patients prophylactically anticoagulated with SQ heparin. 40% of respondents delay restarting prophylactic heparin after delivery. There was no relationship between anticoagulation protocol presence and either of these practices (P>0.05). For other anticoagulation regimens, including enoxaparin 60mg SQ daily and heparin 7500 U SQ BID, delay intervals before attempting neuraxial anesthesia varied greatly among respondents (figure).
Conclusion: Few academic obstetric anesthesiology units report possessing institutional, obstetric-specific guidelines for neuraxial anesthesia management in anticoagulated women. Significant practice variability exists even with defined ASRA recommendations. Clear and comprehensive guidelines will be beneficial to ensure safe and consistent access to neuraxial analgesia as thromboprophylaxis becomes more prevalent.
1. D’Alton ME: Anesth Analg 2016;128:688-98