Table 5.
Trimester | Anticoagulation at time of bleeding event | Severity of bleeding event (CTCAE* grade) | Treatment | |||
---|---|---|---|---|---|---|
First (n=10) | Aspirin | 4 | 1 | 8 | Observation/uterotonic | 8 |
Prophylactic heparin† | 2 | 2 | 1 | medications | 1 | |
Therapeutic heparin† | 3 | Volume replacement/blood | 1 | |||
VKA‡ | 1 | transfusion/factor complex | ||||
Interventional treatment | ||||||
Second (n=10) (APH n=8, PPH n=2) | Aspirin | 4 | 1 | 6 | Observation/uterotonic | 5 |
Therapeutic heparin† | 1 | 3 | 2 | medications | 1 | |
VKA‡ | 2 | Volume replacement/blood | 3 | |||
Combo§ | 3 | transfusion/factor complex | ||||
Interventional treatment | ||||||
Third (n=18) (APH n=4, PPH n=14) | None | 3 | 1 | 9 | Observation/uterotonic | 11 |
Aspirin | 5 | 2 | 5 | medications | 5 | |
Prophylactic heparin† | 1 | 4 | 3 | Volume replacement/blood | 1 | |
Therapeutic heparin† | 6 | transfusion/factor complex | 2 | |||
VKA‡ | 1 | Interventional treatment | ||||
Combo§ | 1 | surgery | ||||
Type of event | ||||||
Antepartum haemorrhage (n=17) | Aspirin | 6 | 1 | 11 | Observation/uterotonic | 11 |
Prophylactic heparin† | 3 | 2 | 3 | medications | 2 | |
Therapeutic heparin† | 3 | 3 | 1 | Volume replacement/blood | 2 | |
VKA‡ | 3 | transfusion/factor complex | ||||
Combo§ | 2 | Interventional treatment | ||||
Postpartum haemorrhage (n=16) | None | 3 | 1 | 10 | Observation/uterotonic | 11 |
Aspirin | 5 | 2 | 3 | medications | 4 | |
Prophylactic heparin† | 1 | 4 | 1 | Volume replacement/blood | 2 | |
Therapeutic heparin† | 5 | transfusion/factor complex | ||||
VKA‡ | 1 | Interventional treatment | ||||
Combo§ | 1 | |||||
Intracranial haemorrhage (n=1) | Combo§ | 1 | III | 1 | Interventional treatment | 1 |
Other (n=4) | Aspirin | 2 | I | 2 | Observation/uterotonic medications | 2 |
Therapeutic heparin† | 2 | IV | 2 | Unknown | 2 |
NIH/NCI Common Terminology Criteria for Adverse Events.
Heparin here refers to either unfractionated heparin or low molecular weight heparin.
Vitamin K antagonist.
Combination of anticoagulation/antiplatelet medications.
APH, antepartum haemorrhage; PPH, postpartum haemorrhage.