Anticoagulation with argatroban in a parturient with heparin-induced thrombocytopenia

• Published in: International journal of obstetric anesthesia Vol. 19; no. 1; pp. 82 - 87
• Main Authors: Ekbatani, A, Asaro, L.R, Malinow, A.M
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-01-2010
• Subjects: Adult; Anesthesia & Perioperative Care; Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthesia, Spinal; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Anticoagulation; Argatroban; Female; Heparin - adverse effects; Heparin-induced thrombocytopenia; Humans; Obstetric; Obstetrics and Gynecology; Pipecolic Acids - therapeutic use; Platelet Aggregation Inhibitors - therapeutic use; Polysaccharides - therapeutic use; Pregnancy; Thrombocytopenia - blood; Thrombocytopenia - chemically induced; Thrombocytopenia - complications; Thromboembolism; Argatroban; Anticoagulation; Obstetric; Thromboembolism; Heparin-induced thrombocytopenia
• ISSN: 0959-289X; 1532-3374
• DOI: 10.1016/j.ijoa.2009.01.012

Abstract Unfractionated heparin and low-molecular-weight heparin are currently the anticoagulants of choice for the prevention of recurrent thromboembolic disease during pregnancy. However, heparin-induced thrombocytopenia contraindicates the use of unfractionated heparin and low-molecular-weight heparin. We describe a patient who was admitted to our hospital with deep vein thrombosis at 18 weeks of gestation and who developed heparin-induced thrombocytopenia during her antenatal care. Therapeutic anticoagulation was initially achieved with argatroban, then changed to fondaparinux. During early labor, fondaparinux was discontinued and intravenous argatroban was substituted. Argatroban was discontinued during transition to active labor. After return of a normal partial thromboplastin time, combined spinal-epidural analgesia was induced for routine completion of labor and vaginal delivery. We discuss the decisions made in the maintenance of this patient’s anticoagulation during the peripartum period as well as timing of her neuraxial labor analgesia.