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Clinical Obstetrics

Poster Session 2

(383) Candidacy for Regional Anesthesia Stratified by Anticoagulation Type

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

In women on anticoagulation in pregnancy, low molecular weight heparin (LMWH) is often preferred due to lower dosing frequency when compared to unfractionated heparin (UFH). However, its longer half-life can theoretically increase risk of hemorrhage and inability to receive regional anesthesia. For these reasons, guidelines suggest transition from LMWH to UFH at 36 weeks’ gestation. However, many patients will have a scheduled delivery or present with enough time to receive regional anesthesia. The objective of this study is to describe rates of receipt of regional anesthesia by type of anticoagulation at time of delivery. 


Study Design:

This was a retrospective cohort study of all patients on anticoagulation in pregnancy delivering at a single institution between 2013-2023. Women were categorized by anticoagulation type (UFH or LMWH). The primary outcome was receipt or non-receipt of regional anesthesia. Secondary outcomes included rates of postpartum hemorrhage (PPH) and transfusion. Univariate analysis was performed using the chi-square and Wilcoxon rank sum test where appropriate.


Results:

346 patients were included in the analysis with 238 (68.8%) on UFH and 108 (31.2%) on LMWH at time of delivery. There were baseline differences between groups including higher rates of Black race (55.6% vs 41.1%; p=.022) and therapeutic dosing (32.4% vs 14.7%; p< .001) among patients taking LMWH. There were no differences in rates of regional anesthesia (84.3% vs 89.1%; p=.208). There were increased rates of non-candidacy for regional anesthesia (5.6% vs 1.3%; p=.020) in the LMWH group. However, when restricting to deliveries > 36 weeks, there was no difference seen between groups (p=.417; Table 1). There were no differences in rates of PPH (p=.581) and transfusion due to blood loss (p=.097) 


Conclusion:

There was no difference in rate of receipt of regional anesthesia, but non-candidacy was higher among patients taking LMWH versus UFH at delivery. However, this finding was not significant when restricting to those delivering after 36 weeks.