Low dose aspirin (labor or c-section)

[autumnx]

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Patients normally treated for thrombophilia use Heparin since it's out of your system relatively quickly. What about patients on low dose aspirin therapy in cases of an emergency c-section or labor with epidural? Last dose taken same day.

 

[deleted59964]

what is your question?

 

[sleepallday]

Patients normally treated for thrombophilia use Heparin since it's out of your system relatively quickly. What about patients on low dose aspirin therapy in cases of an emergency c-section or labor with epidural? Last dose taken same day.

I'm going to assume that your not an anesthesiologist since your asking this question but neuraxial anesthesia is not contraindicated with low dose aspirin therapy

 

[deleted171991]

It doesn't matter that it's "low dose". ASA is antiaggregant even at low doses. It's a risks vs. benefits informed consent (the risk for spinal/epidural hematoma is very low, possibly negligible, but I would still follow the patient neurologically, and the symptoms/signs should be promptly recognized and treated).

 

[BuzzPhreed]

Consensus guidelines state there are no contraindications with neuraxial anesthesia and NSAIDs/ASA.

http://www.nysora.com/mobile/region...-of-ra/3300-ra-in-anticoagulated-patient.html

http://bja.oxfordjournals.org/content/107/suppl_1/i96.full

http://www.uptodate.com/contents/ne...hrombotic-medication-anticoagulant#H262596028

https://www.glowm.com/resources/glowm/cd/pages/v3/v3c091.html

 

[deleted171991]

I saw that. I was looking for specific ASRA guidelines.

Edit:
Found them. Interesting quote from there:

Depending on the dose administered, aspirin (and other NSAIDs) may produce opposing effects on the hemostatic mechanism. For example, platelet cyclooxygenase is inhibited by low-dose aspirin (60-325 mg/d), whereas larger doses (1.5-2 g/d) will also inhibit the production of prostacyclin (a potent vasodilator and platelet aggregation inhibitor) by vascular endothelial cells and thus result in a paradoxical thrombogenic effect. As a result, low-dose aspirin (81-325 mg/d) is theoretically a greater risk factor for bleeding than higher doses. Spontaneous and postoperative (unrelated to neuraxial technique) spinal hematomas have been reported with low-dose aspirin therapy.

Still:

Nonsteroidal anti-inflammatory drugs seem to represent no added significant risk for the development of spinal hematoma in patients having epidural or spinal anesthesia. Non-steroidal anti-inflammatory drugs (including aspirin) do not create a level of risk that will interfere with the performance of neuraxial blocks. In patients receiving these medications, we do not identify specific concerns as to the timing of single-shot or catheter techniques in relationship to the dosing of NSAIDs, postoperative monitoring, or the timing of neuraxial catheter removal (Grade 1A).

 

[BuzzPhreed]

There you have it.