. "4"^^ . "Bl\u00E1hov\u00E1, Kate\u0159ina" . . . . . . "Noskov\u00E1, Pavl\u00EDna" . "4"^^ . "Spinal hematoma (SH) after neuraxial puncture is considered the most serious complication of regional anaesthesia. The risk is further significantly increased by co-administration of thromboprophylaxis with low molecular weight heparins (LMWH). In the 1990s, the risk of SH on the basis of published case reports was estimated as 1 : 1 000 000. These estimates are now closer to 1 : 3 000. Concomitant application of LMWH is responsible for such a dramatic increase of the risk of SH, especially in orthopaedics. Therefore, a number of anaesthesiology societies have adopted a recommendation concerning the time relation between the administration of neuraxial anaesthesia and LMWH applications. Generally, the risks are only approximated for the low incidence of SH, and for pregnant women this risk is estimated between 1 : 200 000 and 1 : 400 000. If there is an increased risk of SH with concomitant LMWH in orthopaedic patients, in the case of obstetric anaesthesia this increased risk is very questionable. So far there has not been a single published case report giving the context of SH and LMWH use in pregnancy, which, in addition to the physiological hypercoagulable state, differs in altered pharmacokinetics and pharmacodynamics of LMWH. The following text attempts to summarize the current information available regarding the relation of thromboprophylaxis and the risk of spinal hematoma in obstetrics."@en . "LMWH; thromboprophylaxis; regional anaesthesia; spinal haematoma; pregnancy"@en . "Anesteziologie a intenzivn\u00ED medic\u00EDna" . "Tromboprofylaxe a neuroaxi\u00E1ln\u00ED anestezie v porodnictv\u00ED"@cs . . . "CZ - \u010Cesk\u00E1 republika" . "Tromboprofylaxe a neuroaxi\u00E1ln\u00ED anestezie v porodnictv\u00ED" . . . "Bl\u00E1ha, Jan" . "Thromboprophylaxis and neuroaxial anaesthesia in obstetrics"@en . . . . "Koln\u00EDkov\u00E1, Ivana" . "RIV/00064165:_____/12:12865" . . . "8"^^ . "1" . "Tromboprofylaxe a neuroaxi\u00E1ln\u00ED anestezie v porodnictv\u00ED" . . . . "http://www.prolekare.cz/anesteziologie-intenzivni-medicina-clanek/tromboprofylaxe-a-neuroaxialni-anestezie-v-porodnictvi-37505" . "V" . "Vznik spin\u00E1ln\u00EDho hematomu (SH) p\u0159i neuroaxi\u00E1ln\u00ED punkci je pova\u017Eov\u00E1n za nejz\u00E1va\u017En\u011Bj\u0161\u00ED komplikaci region\u00E1ln\u00ED anestezie, jej\u00ED\u017E riziko v\u00FDznamn\u011B stoup\u00E1 p\u0159i sou\u010Dasn\u00E9 aplikaci tromboprofylaxe n\u00EDzkomolekul\u00E1rn\u00EDmi hepariny (LMWH). Jestli\u017Ee v 90. letech minul\u00E9ho stolet\u00ED se riziko SH na podklad\u011B publikovan\u00FDch kazuistik odhadovalo na 1 : 1 000 000, dnes se tyto odhady bl\u00ED\u017E\u00ED a\u017E hranici 1 : 3 000. Za takto dramatick\u00FD vzestup rizika SH, p\u0159edev\u0161\u00EDm v ortopedii, jsou zodpov\u011Bdn\u00E9 pr\u00E1v\u011B sou\u010Dasn\u011B aplikovan\u00E9 LMWH. \u0158adou odborn\u00FDch spole\u010Dnost\u00ED proto byla p\u0159ijata doporu\u010Den\u00ED, t\u00FDkaj\u00EDc\u00ED se \u010Dasov\u00FDch souvislost\u00ED mezi pod\u00E1n\u00EDm neuroaxi\u00E1ln\u00ED anestezie a aplikac\u00ED LMWH. Pro n\u00EDzkou \u010Detnost v\u00FDskytu jsou obecn\u011B rizika SH pouze odvozena, p\u0159i\u010Dem\u017E pro t\u011Bhotn\u00E9 \u017Eeny se toto riziko odhaduje mezi 1 : 200 000 a\u017E 1 : 400 000. Jestli\u017Ee u ortopedick\u00FDch \u010Di chirurgick\u00FDch pacient\u016F existuje zv\u00FD\u0161en\u00E9 riziko vzniku SH p\u0159i sou\u010Dasn\u00E9 aplikaci LMWH, tak v p\u0159\u00EDpad\u011B porodnick\u00E9 anestezie je toto zv\u00FD\u0161en\u00E9 riziko velmi nepravd\u011Bpodobn\u00E9. Doposud nebyla publikov\u00E1na ani jedin\u00E1 kazuistika d\u00E1vaj\u00EDc\u00ED do souvislosti SH a aplikaci LMWH v t\u011Bhotenstv\u00ED, kter\u00E9 se vedle fyziologick\u00E9ho hyperkoagula\u010Dn\u00EDho stavu li\u0161\u00ED i zm\u011Bn\u011Bnou farmakokinetikou a farmakodynamikou LMWH. N\u00E1sleduj\u00EDc\u00ED text se proto sna\u017E\u00ED podat souhrn dnes dostupn\u00FDch informac\u00ED t\u00FDkaj\u00EDc\u00EDch se vztahu tromboprofylaxe a rizika vzniku spin\u00E1ln\u00EDho hematomu v porodnictv\u00ED." . "175235" . "Vznik spin\u00E1ln\u00EDho hematomu (SH) p\u0159i neuroaxi\u00E1ln\u00ED punkci je pova\u017Eov\u00E1n za nejz\u00E1va\u017En\u011Bj\u0161\u00ED komplikaci region\u00E1ln\u00ED anestezie, jej\u00ED\u017E riziko v\u00FDznamn\u011B stoup\u00E1 p\u0159i sou\u010Dasn\u00E9 aplikaci tromboprofylaxe n\u00EDzkomolekul\u00E1rn\u00EDmi hepariny (LMWH). Jestli\u017Ee v 90. letech minul\u00E9ho stolet\u00ED se riziko SH na podklad\u011B publikovan\u00FDch kazuistik odhadovalo na 1 : 1 000 000, dnes se tyto odhady bl\u00ED\u017E\u00ED a\u017E hranici 1 : 3 000. Za takto dramatick\u00FD vzestup rizika SH, p\u0159edev\u0161\u00EDm v ortopedii, jsou zodpov\u011Bdn\u00E9 pr\u00E1v\u011B sou\u010Dasn\u011B aplikovan\u00E9 LMWH. \u0158adou odborn\u00FDch spole\u010Dnost\u00ED proto byla p\u0159ijata doporu\u010Den\u00ED, t\u00FDkaj\u00EDc\u00ED se \u010Dasov\u00FDch souvislost\u00ED mezi pod\u00E1n\u00EDm neuroaxi\u00E1ln\u00ED anestezie a aplikac\u00ED LMWH. Pro n\u00EDzkou \u010Detnost v\u00FDskytu jsou obecn\u011B rizika SH pouze odvozena, p\u0159i\u010Dem\u017E pro t\u011Bhotn\u00E9 \u017Eeny se toto riziko odhaduje mezi 1 : 200 000 a\u017E 1 : 400 000. Jestli\u017Ee u ortopedick\u00FDch \u010Di chirurgick\u00FDch pacient\u016F existuje zv\u00FD\u0161en\u00E9 riziko vzniku SH p\u0159i sou\u010Dasn\u00E9 aplikaci LMWH, tak v p\u0159\u00EDpad\u011B porodnick\u00E9 anestezie je toto zv\u00FD\u0161en\u00E9 riziko velmi nepravd\u011Bpodobn\u00E9. Doposud nebyla publikov\u00E1na ani jedin\u00E1 kazuistika d\u00E1vaj\u00EDc\u00ED do souvislosti SH a aplikaci LMWH v t\u011Bhotenstv\u00ED, kter\u00E9 se vedle fyziologick\u00E9ho hyperkoagula\u010Dn\u00EDho stavu li\u0161\u00ED i zm\u011Bn\u011Bnou farmakokinetikou a farmakodynamikou LMWH. N\u00E1sleduj\u00EDc\u00ED text se proto sna\u017E\u00ED podat souhrn dnes dostupn\u00FDch informac\u00ED t\u00FDkaj\u00EDc\u00EDch se vztahu tromboprofylaxe a rizika vzniku spin\u00E1ln\u00EDho hematomu v porodnictv\u00ED."@cs . "RIV/00064165:_____/12:12865!RIV13-MZ0-00064165" . . "23" . "[32F69224B420]" . . "1214-2158" . "Thromboprophylaxis and neuroaxial anaesthesia in obstetrics"@en . "Tromboprofylaxe a neuroaxi\u00E1ln\u00ED anestezie v porodnictv\u00ED"@cs .