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Prophylactic Unfractionated Heparin and PTT in Antepartum Patients
Abstract Number: S2A-1
Abstract Type: Original Research
Background: Venous thromboembolism (VTE) is a leading cause of maternal morbidity/mortality (1). Heparin prophylaxis is recommended in many pregnant patients, including most hospitalized antepartum patients (2). While checking PTT before neuraxial procedures in patients receiving heparin prophylaxis is common practice (3), the need to check PTT is unclear as the incidence of prophylactic heparin-induced coagulopathy and thrombocytopenia among parturients is unknown. Furthermore, waiting for PTT values may delay care and increase use of general anesthesia for urgent cesarean delivery, which is associated with more adverse outcomes than neuraxial anesthesia (4). Our aim was to determine the incidence of abnormal PTT and platelet values in hospitalized antepartum patients receiving heparin prophylaxis.
Methods: In this IRB-approved study we retrospectively reviewed medical records of pregnant patients at our institution who received heparin prophylaxis according to institutional protocol from June 2016 until July 2017. The protocol calls for hospitalized antepartum patients to receive prophylactic heparin unless a contraindication exists (5000 U BID in the first trimester, 7500 U BID in the second trimester, 10,000 U BID in the third trimester); PTT values are obtained 2 hours after the third dose of heparin, and platelet counts after 4 days, with dose-adjustment as needed. Data included demographics, comorbidities, heparin doses, PTT/platelet counts, creatinine if available, and anesthetic type.
Results: Of 142 patients who met inclusion criteria, 5 of 18 (28%) who received 10,000 daily units of heparin had PTT elevations, 3 of whom had known renal disease or creatinine >0.8 (table). 23 of 65 (35%) receiving 15,000 daily units had PTT elevations, 3 of whom had renal disease/creatinine >0.8. 29 of 77 (38%) receiving 20,000 daily units had PTT elevations, including 5 with PTT >50 sec. Only 5 of the 29 had renal disease/creatinine >0.8. Five patients received general anesthesia due to heparin therapy.
Conclusion: PTT should be checked prior to neuraxial procedures in patients receiving >10,000 U heparin daily. Furthermore, PTT should be checked in patients with renal insufficiency no matter the dose of heparin.
References: 1) Creanga: Obstet Gynecol 2015;125:5 2) D’Alton: Obstet Gynecol 2016;128:688 3) Leffert: Anesth Analg 2018; epub ahead of print 4) Guglielminotti: Anesthesiology 2015;123:1013