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Neuraxial Anesthesia in Obstetric Patients Receiving Thromboprophylaxis With Unfractionated or Low–Molecular-Weight Heparin: A Systematic Review of Spinal Epidural Hematoma

Leffert, L.R.; Dubois, H.M.; Butwick, A.J.; Carvalho, B.; Houle, T.T.; Landau, R.

Obstetric Anesthesia Digest: March 2018 - Volume 38 - Issue 1 - p 3–4
doi: 10.1097/01.aoa.0000529964.63597.d5
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(Anesth Analg. 2017;125(1):223–231)

National guidelines stipulate that pregnant women at risk for venous thromboembolism, such as women undergoing cesarean delivery (4-fold increased risk compared with vaginal delivery), receive thromboprophylaxis via mechanical means, low–molecular-weight heparin (LMWH) and or unfractionated heparins (UFHs). Because of a limited number of studies addressing the boundaries for safe use of neuraxial anesthesia in obstetric patients receiving thromboprophylaxis, or anticoagulated patients, the authors of the present review report on all cases of spinal epidural hematoma (SEH) after neuraxial blockade in this population of obstetric patients.

Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA; Department of Anesthesia, Stanford University School of Medicine, Stanford, CA; and Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY

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