TITLE:
Heparin and other anticoagulants in amniotic fluid embolism (AFE): Literature review and concept of the therapy
AUTHORS:
Mieczysław Uszyński, Waldemar Uszyński
KEYWORDS:
Amniotic Fluid Embolism; Disseminated Intravascular Coagulation; Heparin; Low Molecular Weight Heparin; Antithrombin
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.3 No.7,
September
27,
2013
ABSTRACT:
Aim: The objective of this study is to review all the reported outcomes of heparin
application in amniotic fluid embolism (AFE) so far and to find out why, when
and how heparin or other anticoagulants should be used in AFE. Material and
methods: We searched Medline (from 1969 to 2011), using two key words: 1) amniotic
fluid embolism; 2) amniotic fluid embolism and heparin. The search for the
former produced 1127 replies, of which 208 were case reports of AFE. In
response to the other key word, there were 94 articles. We looked through all
the articles, selecting those relevant for our study. Results: In the years
1969-2011, 208 AFE cases were reported. Heparin (unfractionated heparin) or low
molecular weight heparin (LMWH) was applied in 20 cases (9.6%), being the main
drug in 11 cases (5.3%) and in 6 cases as a component of spectacular treatment
of AFE (surgical treatment and extracorporal membrane oxygenation). In one of
these cases anithrombin (AT) with LMWH was used. In one patient heparin therapy
was considered to be unsuccessful and hence recombinant plasminogen activator
(rt-PA) was instituted. All the patients survived. Conclusions: 1) The attempts
to use heparin in AFE could be defined as promising, although the number of
treated patients is too small for conclusion; 2) The postulate to use heparin
at the very onset of AFE (a bolus of 10,000 U followed by monitored intravenous
infusion) has serious justification: one of the pathways of AFE is the target
for heparin (coagulation pathway).