Reconsidering the switch from low-molecular-weight heparin to unfractionated heparin during pregnancy

L. D. Pacheco, G. R. Saade, M. M. Costantine, R. Vadhera, G. D.V. Hankins

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations


Venous thromboembolic disease accounts for 9% of all maternal deaths in the United States. In patients at risk for thrombosis, common practice is to start prophylactic doses of low-molecular-weight heparin and transition to unfractionated heparin during the third trimester, with the perception that administration of neuraxial anesthesia will be safer while on unfractionated heparin, as spinal/epidural hematomas have been associated with recent use of low-molecular-weight heparin. In patients receiving prophylactic doses of unfractionated heparin, neuraxial anesthesia may be placed, provided the dose used is 5,000 units twice a day. The American Society of Regional Anesthesia and Pain Medicine guidelines recognize that the safety of neuraxial anesthesia in patients receiving more than 10,000 units per day or more than 2 doses per day is unknown, limiting the theoretical benefit of unfractionated heparin at doses higher than 5,000 units twice a day.

Original languageEnglish (US)
Pages (from-to)655-658
Number of pages4
JournalAmerican Journal of Perinatology
Issue number8
StatePublished - Sep 2014


  • low-molecular-weight heparin
  • neuraxial anesthesia
  • unfractionated heparin

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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