Should COVID-Positive Pregnant Patients with Thrombocytosis get Prophylactic Anticoagulation for Stroke in Labor?

ABSTRACT

Clinical manifestation of coronavirus (COVID-19) is known to be associated with a hypercoagulable state and has a correlation of stroke as observed during the COVID pandemic. Pregnancy augments physiologic estrogenic effects on coagulation, making pregnant patients hypercoagulable. Management of hypercoagulability includes anticoagulation, which poses a contraindication to neuraxial anesthesia based on current guidelines. Management of primary labor anesthesia modality in patients with thrombocytosis can be challenging, particularly when presented with concurrent COVID infection. There is no guideline on the administration of anti-coagulation in this populace. The risk-benefit stratification of neuraxial anesthesia versus general anesthesia needs to be reviewed in such a patient population. We present a case of a parturient in labor who had thrombocytosis with a platelet of 576, COVID infection, and received therapeutic anticoagulation based on an automatic EMR best practices protocol. In this report, we examine literature surrounding the intersection of COVID, pregnancy, thrombocytosis and neuraxial anesthesia with respect to coagulation status to better guide anesthetic management in patients.