Balancing Anticoagulation and Neuraxial Procedures in the Peripartum Period: An Update.
Thrombotic pulmonary and venous embolism remains a leading cause of maternal mortality in the United States, prompting expanded venous thromboembolism prophylaxis guidelines from organizations such as the American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynaecologists, American College of Chest Physicians, and American Society of Hematology. Increased pharmacologic thromboprophylaxis, particularly with heparins, complicates decisions regarding neuraxial anesthesia due to the risk of spinal epidural hematoma, while general anesthesia carries higher maternal risks. Guidance from the Society for Obstetric Anesthesia and Perinatology and American Society of Regional Anesthesia and Pain Medicine supports individualized risk assessment.