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Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
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Coagulation screening before epidural analgesia in pre-eclampsia.

P Barker1, C C Callander

  • 1Department of Anaesthetics, University Hospital of Wales, Cardiff, UK.

Anaesthesia
|January 1, 1991
PubMed
Summary

Routine coagulation screens for pre-eclamptic patients needing epidurals are not standardized. Significant abnormalities are rare, occurring only in severe pre-eclampsia, suggesting targeted platelet count testing.

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Area of Science:

  • Obstetrics and Gynecology
  • Anesthesiology
  • Hematology

Background:

  • Current practice for coagulation screening in pre-eclamptic patients undergoing epidural procedures lacks standardization across UK obstetric units.
  • A significant portion of UK deliveries were covered by the initial survey, highlighting the widespread nature of this practice variation.

Purpose of the Study:

  • To investigate the utility and yield of routine coagulation screening in pre-eclamptic patients considered for epidural analgesia.
  • To determine if current coagulation testing practices align with the actual incidence of coagulation abnormalities in this patient population.

Main Methods:

  • Retrospective audit of 434 coagulation screens requested for pre-eclamptic patients.
  • Analysis of coagulation parameters, including platelet counts, in relation to pre-eclampsia severity.

Main Results:

  • Only 2% of patients exhibited borderline coagulation abnormalities.
  • Thrombocytopenia (platelet count < 150 x 10(9)/litre) was present in 28% of cases.
  • Significant thrombocytopenia (< 100 x 10(9)/litre) and all coagulation abnormalities were exclusively found in severe pre-eclampsia cases, often associated with reduced platelet counts.

Conclusions:

  • Coagulation testing in pre-eclamptic patients undergoing epidural procedures should be restricted to cases of severe pre-eclampsia.
  • For severe pre-eclampsia, initial coagulation assessment can be limited to a platelet count.
  • This approach can streamline anesthetic practice and resource utilization.