Pregnant Patients on Anticoagulants
The main goal in parturients receiving anticoagulation and neuraxial anesthesia is to balance the risks of spinal epidural hematoma (SEH) versus benefits of neuraxial techniques for safer maternal and fetal outcomes. An understanding of the unique pregnancy associated physiological pharmacokinetic and pharmacodynamic changes, along with advanced patient centric planning as part of multidisciplinary team approach requires vigilant deliberation.
Prevention of SEH entails adherence to current guidelines for timing neuraxial block insertion/catheter removal with the last or subsequent dose of anticoagulant, along with use of dilute solutions of local anesthetics. Vigilant monitoring is essential to detect early neurological symptoms which may thwart progression to permanent sequelae.
KeywordsNeuraxial analgesia/anesthesia Anticoagulation Pregnancy Spinal epidural hematoma
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