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Anesth Analg 2005;101:1821-1823
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000184135.00502.3E

OBSTETRIC ANESTHESIA

The Use of Central Neuraxial Techniques in Parturients with Factor V Leiden Mutation

Miriam J. Harnett, MB, FFARCSI, Mary E. Walsh, MB, FFARCSI, Thomas F. McElrath, MD, PhD, and Lawrence C. Tsen, MD

Departments of Anesthesia, Perioperative and Pain Medicine, and Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts

Address correspondence and reprint requests to Lawrence C. Tsen, MD, Department of Anesthesia, Perioperative and Pain Med, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115. Address e-mail to ltsen{at}zeus.bwh.harvard.edu.

The factor V Leiden (FVL) mutation is a leading cause of thrombosis, particularly during pregnancy. During pregnancy, women with thrombotic disorders including FVL are often considered candidates for antepartum anticoagulation with low molecular weight heparin. Pregnancy complications related to thrombosis and the unpredictable timing of labor cause unique challenges with regard to the provision of regional anesthesia. A patient with heterozygotic FVL presenting with thrombotic disease and a complicated anticoagulation status lead us to review 16 additional parturients with FVL. This report focuses on the anesthetic implications that arise in parturients with FVL. We recommend that anesthesiologists be made aware of FVL patients before their due date, anticoagulation with low molecular weight heparin should be transitioned to unfractionated heparin before the 38th gestational week, and multidisciplinary collaborative investigation and care should continue for this disorder.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.