TY - JOUR
T1 - Onset of labor and use of analgesia in women using thromboprophylaxis with 2 doses of low-molecular-weight heparin
T2 - insights from the Highlow study
AU - Bistervels, Ingrid M.
AU - Wiegers, Hanke M. G.
AU - Áinle, Fionnuala Ní
AU - Bleker, Suzanne M
AU - Chauleur, Céline
AU - Donnelly, Jennifer
AU - Jacobsen, Anne F.
AU - Rodger, Marc A.
AU - DeSancho, Maria T.
AU - Verhamme, Peter
AU - Hansen, Anette T.
AU - Shmakov, Roman G.
AU - Ganzevoort, Wessel
AU - Buchmüller, Andrea
AU - Middeldorp, Saskia
AU - Highlow Investigators
N1 - Copyright © 2022 International Society on Thrombosis and Haemostasis. All rights reserved.
PY - 2023/1
Y1 - 2023/1
N2 - 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.
AB - 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.
KW - Analgesia
KW - Anticoagulants/therapeutic use
KW - Female
KW - Heparin, Low-Molecular-Weight/therapeutic use
KW - Humans
KW - Male
KW - Pregnancy
KW - Venous Thromboembolism/drug therapy
KW - pregnancy
KW - low-molecular-weight
KW - obstetric
KW - anesthesia and analgesia
KW - labor
KW - heparin
KW - venous thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85147048363&partnerID=8YFLogxK
U2 - 10.1016/j.jtha.2022.11.004
DO - 10.1016/j.jtha.2022.11.004
M3 - Journal article
C2 - 36695396
SN - 1538-7933
VL - 21
SP - 57
EP - 67
JO - Journal of Thrombosis and Haemostasis
JF - Journal of Thrombosis and Haemostasis
IS - 1
ER -