Neuraxial anesthesia in anticoagulated parturient-should we cancel ?

ABSTRACT

In this prospective study 16 parturients on chronic anticoagulant therapy for a history of life-threatening thromboembolic disease were scheduled for elective cesarean section under neuraxial block. They stopped taking warfarin 5 days prior to surgery and LMWH [1.5 mg.kg-1] was given twice daily sc 3 days before the operation. Heparin was stopped 12 hours before surgery regarding INR < 1.4 and restarted in the first post operative day/ Warfarin was restarted together with LMWH after stabilization of the patients medical conditions. LMWH was discontinued when INR > 2. The results were compared to a control group comprised of 16 randomly selected non warfarin treated parturients who underwent elective CS during the same period. Mean perioperative decrease in hemoglobin was 1.3 +/- 0.3 gm/dL and 1.4 +/- 0.1 gm/dL in heparin and control group respectively. The need for blood transfusion did not significantly differ between the two groups. Average hospitalization period in heparin group was 4.3 +/- 0.5 days compared to 2.2 +/- 0.3 days in the control group [P < 0.01]. No long term hemorrhage or thromboembolic complications were recorded 3 months postoperatively. Elective cesarean section under neuraxial block can be conducted safely in those high risk patients with regimen that allows a brief but controlled interruption to their full anticoagulation