Document Detail


Anticoagulation with argatroban in a parturient with heparin-induced thrombocytopenia.
MedLine Citation:
PMID:  19625181     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Unfractionated heparin and low-molecular-weight heparin are currently the anticoagulants of choice for the prevention of recurrent thromboembolic disease during pregnancy. However, heparin-induced thrombocytopenia contraindicates the use of unfractionated heparin and low-molecular-weight heparin. We describe a patient who was admitted to our hospital with deep vein thrombosis at 18 weeks of gestation and who developed heparin-induced thrombocytopenia during her antenatal care. Therapeutic anticoagulation was initially achieved with argatroban, then changed to fondaparinux. During early labor, fondaparinux was discontinued and intravenous argatroban was substituted. Argatroban was discontinued during transition to active labor. After return of a normal partial thromboplastin time, combined spinal-epidural analgesia was induced for routine completion of labor and vaginal delivery. We discuss the decisions made in the maintenance of this patient's anticoagulation during the peripartum period as well as timing of her neuraxial labor analgesia.
Authors:
A Ekbatani; L R Asaro; A M Malinow
Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-07-21
Journal Detail:
Title:  International journal of obstetric anesthesia     Volume:  19     ISSN:  1532-3374     ISO Abbreviation:  Int J Obstet Anesth     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-19     Completed Date:  2010-03-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9200430     Medline TA:  Int J Obstet Anesth     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  82-7     Citation Subset:  IM    
Copyright Information:
Copyright 2009 Elsevier Ltd. All rights reserved.
Affiliation:
Departments of Anesthesiology and Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia, Epidural
Anesthesia, Obstetrical
Anesthesia, Spinal
Anticoagulants / adverse effects*,  therapeutic use*
Female
Heparin / adverse effects*
Humans
Pipecolic Acids / therapeutic use*
Platelet Aggregation Inhibitors / therapeutic use*
Polysaccharides / therapeutic use
Pregnancy
Thrombocytopenia / blood,  chemically induced*,  complications*
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Pipecolic Acids; 0/Platelet Aggregation Inhibitors; 0/Polysaccharides; 0/fondaparinux; 74863-84-6/argatroban; 9005-49-6/Heparin

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