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Re: DVT and Pregnancy From: Griffiths Malcolm (Malcolm.Griffiths@ldh-tr.anglox.nhs.uk) Mon Feb 26 09:06:20 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Steve & Eryl Raymond: "Re: who knows about squitting delivery?" Previous message: Griffiths Malcolm: "Re: Pitocin lawsuit" Maybe in reply to: Steven W Crawford: "DVT and Pregnancy" Next in thread: Steve & Eryl Raymond: "Re: DVT and Pregnancy" None of these references seems more than consensus opinion. One of the authors (Ginsberg) is a reproductive endocrinologist! -----Original Message----- From: eramirez@icepr.com [mailto:eramirez@icepr.com] Sent: 24 February 2001 02:22 To: Multiple recipients of list OB-GYN-L Subject: Re: DVT and Pregnancy Well we can argue back and forth ;-) (I chose a happy medium) but we certainly agree that DTV is an indication for prophylaxis - CLINICAL MANAGEMENT GUIDELINES FOR OBSTETRICIAN-GYNECOLOGISTS NUMBER 19, AUGUST 2000 (Replaces Educational Bulletin Number 234, March 1997) Thromboembolism in Pregnancy Unfractionated Heparin Low-dose prophylaxis: 1. 5,000-7,500 U every 12 hours during the first trimester 7,500-10,000 U every 12 hours during the second trimester 10,000 U every 12 hours during the third trimester unless the APTT* is elevated. The APTT may be checked near term and the heparin dose reduced if prolonged OR 2. 5,000-10,000 U every 12 hours throughout pregnancy Adjusted-dose prophylaxis: >,000 U twice a day to three times a day to achieve APTT of 1.5-2.5 Low-Molecular-Weight Heparin Low-dose prophylaxis: Dalteparin, 5,000 U once or twice daily, or enoxaparin, 40 mg once or twice daily Adjusted-dose prophylaxis: Dalteparin, 5,000-10,000 U every 12 hours, or enoxaparin, 30-80 mg every 12 hours *APTT indicates activated partial thromboplastin time. Data from Colvin BT, Barrowcliffe TW. The British Society for Haematology guidelines on the use and monitoring of heparin 1992: second revision. J Clin Pathol 1993;46:97-103. Ginsberg JS, Hirsh J. Use of antithrombotic agents during pregnancy. Chest 1998;114: 524S-530S. Maternal and Neonatal Haemostasis Working Party of the Haemostasis and Thrombosis Task. Guidelines on the presentation, investigation and management of thrombosis associated with pregnancy. J Clin Pathol 1993;46:489-496 At Fri, 23 Feb 2001, J. Hellriegel wrote: > >I agree with Efrain but have not increased dose of hparin until 3rd >trimester. Have also used 5,000 tid in third trimester. > >-- >J. Hellriegel > >At Fri, 23 Feb 2001, Efrain Ramirez wrote: >> >>I don't agree with Malcom - prior DVT is an indication for prophylatic >>low dose heparin -I would give her heparin as you did - increase to >>8,000 BID at 20 weeks - no problem in labor - Lovenox is an alternative >>-- costly - give calcium with Vit D. Antiembolic stockings are Ok - >> >>At Fri, 23 Feb 2001, Griffiths Malcolm wrote: >>> >>>I don't think I or my colleagues would have had this patient on Heparin >>>through pregnancy. We would simply have dad her on low-dose heparin. >>> >>>However if you have decided to use it there are no real special precautions >>>at this dosage needed. >>> >>>If she has CS, I'd use anti-embolism stockings of pneumatic calf compression >>>(or both) as well. >>> >>>-----Original Message----- >>>From: Steven W Crawford [mailto:scrawfmd@zoomnet.net] >>>Sent: 22 February 2001 22:44 >>>To: Multiple recipients of list OB-GYN-L >>>Subject: DVT and Pregnancy >>> >>>Dear List Members, >>> >>>I have a 22 yo G1 at 35 weeks gest, who has been on Heparin 5,000 units >>>SQ. BID since 18 weeks gestation. >>> >>>She is on Heparin due to her history of a left leg DVT a couple of years >>>ago. >>> >>>What should I do at time of delivery? Stop Heparin soon? Any >>>difference in management if she has a c-section versus a vaginal >>>delivery? >>> >>>Thank you very much for your help! >>> >>>Steven Crawford, MD >>>OB/GYN >>>Ohio >> >>-- >>"Life is neither the notes nor the silence between the notes, but the music that >> arises out of sound and silence felt as a living whole. Stop choosing...between >> chaos and order, and live at the boundary between them, where rest and action >> move together..." David Whyte >> >-- >John Hellriegel, MD, PhD > -- "Life is neither the notes nor the silence between the notes, but the music that arises out of sound and silence felt as a living whole. Stop choosing...between chaos and order, and live at the boundary between them, where rest and action move together..." David Whyte ********************************************************************** This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you have received this email in error please notify the system manager. This footnote also confirms that this email message has been swept by MIMEsweeper for the presence of computer viruses. ********************************************************************** Next message: Steve & Eryl Raymond: "Re: who knows about squitting delivery?" Previous message: Griffiths Malcolm: "Re: Pitocin lawsuit" Maybe in reply to: Steven W Crawford: "DVT and Pregnancy" Next in thread: Steve & Eryl Raymond: "Re: DVT and Pregnancy"

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