(829) Comparison of Two Methods of Antepartum Anticoagulation: Enoxaparin until scheduled labor versus transitioning to heparin

Pregnancy is a hypercoagulable state. When anticoagulation is required to prevent or treat venous thromboembolism (VTE) during pregnancy, there is a lack of strong evidence-based guidance for management. Low molecular weight heparin (LMWH), like enoxaparin, has more predictable pharmacokinetics but longer half-life compared to heparin. In practice, some are prescribed LMWH and transitioned to heparin in the setting of an unpredictable delivery. Others are continued on LMWH with a scheduled delivery because of the pharmacokinetic benefits, ease of administration and avoidance of multiple mediations. This work evaluates obstetrical and neonatal outcomes between these practices.

Study Design:

Institutional review board approval was obtained. All patients admitted to a regional labor and delivery unit January 2017-May 2022 and were prescribed an anticoagulant home medication were included. Demographic, obstetric and delivery information were abstracted for each patient. Logistical regressions were used to compare outcomes in those who were prescribed enoxaparin versus heparin at time of admission.

Results:

There were 194 deliveries for 179 patients meeting the criteria in this timeframe. 93 patients were prescribed heparin prior to admission; 101 were prescribed enoxaparin. There were no statistically significant differences of demographics, obstetrical or neonatal outcomes between these groups, including estimated blood loss, ability to receive neuraxial anesthesia, birth weight, mode of delivery, or neonatal APGARs. There were no readmissions for bleeding, hematoma, wound infection, or reoperation.

Conclusion:

There is no statistically significant difference between anticoagulation practices in obstetric or neonatal outcomes between groups. The lack of difference in obstetrical outcomes suggests continuing LMWH until a scheduled induction of labor is noninferior to transitioning a patient to heparin.