Blood loss at the time of surgical abortion up to 14 weeks in anticoagulated patients: a case series

Kaneshiro, Bliss; Tschann, Mary; Jensen, Jeffrey T.; Bednarek, Paula H.; Texeira, Ronnie; Edelman, Alison

doi:10.1016/j.contraception.2017.03.003

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…Although SFP do not recommend interrupting anticoagulation for a first-trimester procedure given nonclinically significant increases in blood loss associated with these procedures [27,29,30], the decision for continuation, interruption, or modification of anticoagulation should be individualized for those in the second trimester. Clinicians, in consultation with Hematology, should weigh the risk of thromboembolism in the peri-abortion period with the risk of hemorrhage.…”

Section: Clotting and Bleeding Disordersmentioning

confidence: 99%

Second-trimester abortion care for those with complex medical conditions

Henkel

Blumenthal

2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of the reviewThis review focuses on patients who are most likely to experience morbidity associated with second trimester abortion care and risk mitigation strategies. Recent findingsPrior cesarean birth, particularly multiple prior cesarean births, is the most significant risk factor associated with complications during second trimester abortion because of increased risks of hemorrhage, with or without placenta accreta spectrum (PAS), and distorted anatomy, which increases the risk of uterine perforation. Recent data suggests that first trimester ultrasound findings may be predictive of PAS, including multiple lacunae, abnormal uteroplacental interface, and hypervascularity. Multiple common medications interact with mifepristone and are therefore contraindicated; ulipristal shares mifepristone's selective progesterone receptor modulator activity but does not share the same metabolic pathway. Recent data suggests ulipristal may be an effective adjunct for cervical preparation, avoiding potentially mifepristone's drug--drug interactions. Those ending a pregnancy due to severe early-onset hypertensive disorders have a high rate of clinically significant thrombocytopenia: platelet transfusion is recommended for those with platelets <50 000 per cubic millimeter.

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Section: Clotting and Bleeding Disordersmentioning

confidence: 99%

Second-trimester abortion care for those with complex medical conditions

Henkel

Blumenthal

2022

Current Opinion in Obstetrics &Amp; Gynecology

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“…The number of individuals taking oral anticoagulants or on combined antiplatelet therapy is increasing, due to a number of factors, including increased risk of cardiovascular and peripheral vascular disease; increased prevalence of obesity, diabetes, and hypertension leading to strokes; and prolonged survival after surgery for congenital heart disease [ 14 ]. One study surveying abortion providers caring for women on anticoagulation found that of 52 women presenting on any anticoagulation, 69% had a history of DVT or PE, 11% had a history of thrombophilia (but no VTE), and 19% had an artificial valve [ 15 ].…”

Section: Bleeding Risk With Abortionmentioning

confidence: 99%

“…A study surveying abortion providers who performed procedural abortions on women at 14 weeks or less gestation on anticoagulation found that out of 52 women who presented on anticoagulation medication, anticoagulation was continued in 36 women (69%) (therapeutic anticoagulation was continued in 25 (48%) and subtherapeutic anticoagulation was continued in 11 (21%)); the remaining 16 women (30%) had their anticoagulation discontinued. Of the 36 women that continued on anticoagulation, 28 (78%) had an EBL less than 50 mL, 4 (8%) had an EBL of 51-100 mL, 2 (4%) had an EBL of 101-250 mL, and 2 (4%, 83-and 88-days gestation) had an EBL of 500 mL [ 15 ]. Data was not collected regarding how providers made the decision to continue or not continue anticoagulation in these women.…”

Section: Bleeding Risk With Abortionmentioning

confidence: 99%

“…Evidence based scoring systems such as the Caprini score may help providers further stratify a patient's VTE risk and subsequent anticoagulation management in certain patients [ 49 ]. Based on limited retrospective data [15] and the expert opinion of the authors, for a first-trimester procedural abortion in an individual on anticoagulation who has no additional risk factors for bleeding and is to undergo a procedure that is anticipated to be uncomplicated, anticoagulation can generally continue uninterrupted. (GRADE 2C) For individuals with additional risk factors, care should be individualized.…”

Section: What Perioperative Considerations Should Be Weighed In An Individual With a Bleeding Disorder/on Anticoagulation?mentioning

confidence: 99%

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Society of Family Planning clinical recommendations: Management of individuals with bleeding or thrombotic disorders undergoing abortion

2021

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Individuals who have bleeding disorders, thrombophilias, a history of venous thromboembolism (VTE), or who are taking anticoagulation medication for other reasons may present for abortion. Clinicians should be aware of risk factors and histories concerning for excessive bleeding and thrombotic disorders around the time of abortion. This document will focus on how to approach abortion planning in these individuals . For first-trimester abortion, procedural abortion (sometimes called surgical abortion) is generally preferred over medical management for individuals with bleeding disorders or who are on anticoagulation. First-trimester procedural abortion in an individual on anticoagulation can generally be done without interruption of anticoagulation. The decision to interrupt anticoagulation for a second-trimester procedure should be individualized. Individuals at high risk for VTE can be offered anticoagulation post-procedure. Individuals with bleeding disorders or who are anticoagulated can safely be offered progestin intrauterine devices. Future research is needed to better assess quantitative blood loss and complications rates with abortion in these populations.

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Therapeutic anticoagulation for pulmonary embolism during first-trimester surgical abortion: two case reports

Shim

Patel

2018

Contraception

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Blood loss at the time of surgical abortion up to 14 weeks in anticoagulated patients: a case series

Cited by 3 publications

References 16 publications

Second-trimester abortion care for those with complex medical conditions

Second-trimester abortion care for those with complex medical conditions

Society of Family Planning clinical recommendations: Management of individuals with bleeding or thrombotic disorders undergoing abortion

Therapeutic anticoagulation for pulmonary embolism during first-trimester surgical abortion: two case reports

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