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Onset of labor and use of analgesia in women using thromboprophylaxis with 2 doses of low-molecular-weight heparin: insights from the Highlow study
- Source :
- Journal of Thrombosis and Haemostasis, 21, 57-67, Bistervels, I M, Wiegers, H M G, Áinle, F N, Bleker, S M, Chauleur, C, Donnelly, J, Jacobsen, A F, Rodger, M A, DeSancho, M T, Verhamme, P, Hansen, A T, Shmakov, R G, Ganzevoort, W, Buchmüller, A, Middeldorp, S & Highlow Investigators 2023, ' Onset of labor and use of analgesia in women using thromboprophylaxis with 2 doses of low-molecular-weight heparin : insights from the Highlow study ', Journal of Thrombosis and Haemostasis, vol. 21, no. 1, pp. 57-67 . https://doi.org/10.1016/j.jtha.2022.11.004, Journal of Thrombosis and Haemostasis, 21, 1, pp. 57-67, Journal of thrombosis and haemostasis : JTH, 21(1), 57-67. Wiley-Blackwell
- Publication Year :
- 2023
-
Abstract
- Item does not contain fulltext BACKGROUND: Peripartum management of women using low-molecular-weight heparin (LMWH) varies widely. Minimum time intervals are required between LMWH injection and neuraxial procedure, and they differ by dose. OBJECTIVES: The objective of this study was to describe the onset of labor and use of analgesia in women using LMWH and to compare practices between intermediate-dose and low-dose LMWH. METHODS: In the Highlow study (NCT01828697), 1110 women were randomized to intermediate-dose or low-dose LMWH and were instructed to discontinue LMWH when labor commenced unplanned or 24 hours prior to planned delivery. The required time interval since last injection to receive a neuraxial procedure was ≥24 hours for intermediate-dose LMWH or ≥12 hours for low-dose LMWH. RESULTS: In total, 1018 women had an ongoing pregnancy for ≥24 weeks. Onset of labor was spontaneous in 198 of 509 (39%) women on intermediate-dose LMWH and in 246 of 509 (49%) on low-dose LMWH. With unplanned onset, a neuraxial procedure was performed in 37% on intermediate-dose and in 48% on low-dose LMWH (risk difference -11%, 95% CI -20% to -2%). Based on time interval, 61% on intermediate-dose and 82% on low-dose LMWH were eligible for a neuraxial procedure. With planned onset, 68% on intermediate-dose and 66% on low-dose LMWH received a neuraxial procedure, whereas 81% and 93%, respectively, were eligible for a neuraxial procedure (risk difference -13%, 95% CI -18% to -8%). CONCLUSION: With spontaneous onset of labor, neuraxial procedures were performed less often in women using intermediate-dose LMWH. Irrespective of onset, fewer women on intermediate-dose LMWH than those on low-dose LMWH were eligible for neuraxial procedures based on required time intervals since the last LMWH injection. 01 januari 2023
- Subjects :
- Male
anesthesia and analgesia
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
venous thromboembolism
labor
Hematology
heparin
All institutes and research themes of the Radboud University Medical Center
Anticoagulants/therapeutic use
Heparin, Low-Molecular-Weight/therapeutic use
Pregnancy
low-molecular-weight
obstetric
Humans
Female
pregnancy
Analgesia
Venous Thromboembolism/drug therapy
Subjects
Details
- ISSN :
- 15387933
- Database :
- OpenAIRE
- Journal :
- Journal of Thrombosis and Haemostasis, 21, 57-67, Bistervels, I M, Wiegers, H M G, Áinle, F N, Bleker, S M, Chauleur, C, Donnelly, J, Jacobsen, A F, Rodger, M A, DeSancho, M T, Verhamme, P, Hansen, A T, Shmakov, R G, Ganzevoort, W, Buchmüller, A, Middeldorp, S & Highlow Investigators 2023, ' Onset of labor and use of analgesia in women using thromboprophylaxis with 2 doses of low-molecular-weight heparin : insights from the Highlow study ', Journal of Thrombosis and Haemostasis, vol. 21, no. 1, pp. 57-67 . https://doi.org/10.1016/j.jtha.2022.11.004, Journal of Thrombosis and Haemostasis, 21, 1, pp. 57-67, Journal of thrombosis and haemostasis : JTH, 21(1), 57-67. Wiley-Blackwell
- Accession number :
- edsair.doi.dedup.....f3654d189dac1bc9406534275cd70541