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).
Cite this paper
Uszyński, M. and Uszyński, W. (2013) Heparin and other anticoagulants in amniotic fluid embolism (AFE): Literature review and concept of the therapy. Open Journal of Obstetrics and Gynecology, 3, 593-598. doi: 10.4236/ojog.2013.37106.
 Abenhaim, H.A., Azoulay, L., Kramer, M.S. and Leduc, L. (2008) Incidence and risk factors of amniotic fluid embolismus: A population-based study on 3 million births in the United States. American Journal of Obstetrics & Gynecology, 199, 49e1-49e8.
 Shechtman, M., Ziser, A., Markovits, R. and Rosenberg, B. (1999) Amniotic fluid embolism: Early findings of transesophageal echocardiography. Anesthesia & Analgesia, 89, 1456-1458.
 Stanten, R.D., Iverson, I.G., Daugharty, T.M., Lovett, S.M., Terrt, C. and Blumenstock, E. (2003) Amniotic fluid embolism causing catastrophic pulmonary vasoconstriction: Diagnosis by echocardiogram and treatment by cardiopulmonary bypass. Obstetrics & Gynecology, 102, 496-498. doi:10.1016/S0029-7844(03)00161-3
 James, C.F., Feinglass, N.G., Menke, D.M., Grinton, S.F. and Papadimos, T.J. (2004) Massive amniotic fluid embolism: Diagnosis aided by emergency transesophageal echocardiography. International Journal of Obstetric Anesthesia, 13, 279-283. doi:10.1016/j.ijoa.2004.03.008
 Kumar, V., Khatwani, M., Aneja, S. and Kapur, K.K. (2010) Paradoxical amniotic fluid embolism presenting before caesarean section in a women with an atrial septal defect. International Journal of Obstetric Anesthesia, 19, 94-98. doi:10.1016/j.ijoa.2009.02.014
 Lee, P.H.U., Shulman, M.S., Vellayappan, U., Symes, J.F. and Ollenchock Jr., S.A (2010) Surgical treatment of an amniotic fluid embolism with cardiopulmonary collapse. The Annals of Thoracic Surgery, 90, 1694-1696.
 Esposito, R.A., Grossi, E.A., Coppa, G., Gianola, G., Ferri, D.P., Angelides, E.M. and Andriakos, P. (1990) Successful treatment of shock caused by amniotic fluid embolism with cardiopulmonary bypass and pulmonary artery thromboembolectomy. American Journal of Obstetrics & Gynecology, 163, 572-574.
 Ho, C.-H., Chen, K.-B., Liu, S.-K., Liu, Y.-F., Cheng, H.-C. and Wu, R.-C. (2009) Early application of extracorporeal membrane oxygenation in a patient with amniotic fluid embolism. Acta Anaesthesiologica Taiwanica, 47, 99-102. doi:10.1016/S1875-4597(09)60033-3
 Mc Donnell, N.J., Chan, B.O. and Frengley, R.W. (2007) Rapid reversal of critical haemodynamic compromise with nitric oxide in parturient with amniotic fluid embolism. International Journal of Obstetric Anesthesia, 16, 269-273. doi:10.1016/j.ijoa.2006.10.008
 Gist, R.S., Stafford, I.P., Leibowitz, A.B. and Beilin, Y. (2009) Amniotic fluid embolism. Anesthesia & Analgesia, 108, 1599-1602. doi:10.1213/ane.0b013e31819e43a4
 Brandjes, D.P.M., Schenk, B.E., Buller, H.R. and Ten Cate, J.W. (1991) Management of disseminated intravascular coagulation in obstetrics. The European Journal of Obstetrics & Gynecology and Reproductive Biology, 42, S87-S89.
 Uszyński, M. (2011) Amniotic fluid embolism: Literature review and integrated concept of pathomechanism. Open Journal of Obstetrics and Gynecology, 1, 178-183.
 Haas, S. (2008) New oral Xa and IIa inhibitors: Updates on clinical trial results. Journal of Thrombosis and Thrombolysis, 25, 52-60.
 Gei, A. and Hankins, G.D.V. (2000) Amniotic fluid embolism: An update. Contemporary OB/GYN, 53, 53-64.
 Steiner, P.E. and Lushbaugh, C.C. (1941) Maternal pulmonary embolism by amniotic fluid as a cause of obstetric shock and unexpected deaths in obstetrics. The Journal of the American Medical Association, 117, 1245-1254. doi:10.1001/jama.1941.02820410023008
 Reid, D.E., Weiner, A.E. and Roby, C.C. (1953) Intravascular clotting and afibrinogenemia, the presumptive lethal factors in the syndrome of amniotic fluid embolism. American Journal of Obstetrics & Gynecology, 66, 465-474.
 Maki, M., Tachita, K., Kawasaki, Y. and Nagasawa, K. (1969) Heparin treatment of amniotic fluid embolism. The Tohoku Journal of Experimental Medicine, 97, 155-160. doi:10.1620/tjem.97.155
 Weiner, C.P. (1986) The obstetric patient and disseminated intravascular coagulation. Clinics in Perinatology, 13, 705-717.
 Uszyński, M. (1984) Heparin therapy in the primary phase of amniotic fluid embolism. Thrombosis and Haemostasis, 52, 362.
 Uszyński, M., Bilyk, B., Jesionowski, Z., Uszyński, W. and Koperski, M. (1984) A favourable result of heparin administration in two cases of clinically diagnosed amniotic fluid embolism (in Polish). Ginekologia Polska, 55, 625-630.
 Weitz, D.S. and Weitz, J.I. (2010) Update on heparin: What do we need to know? Journal of Thrombosis and Thrombolysis, 29, 199-207.
 Reyftmann, L., Morau, E., Dechaud, M., Frapier, J.M. and Hedon, B. (2006) Extracorporeal membrane oxygenation therapy for circulatory arrest due to postpartum haemorrhage. Obstetrics & Gynecology, 107, 511-514.
 Hesieh, Y.-Y., Chang, C.-C., Li, P.-C., Tsai, H.-D. and Tsai, C.-H. (2000) Successful placation of extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation as lifesaving therapy for a patient with amniotic fluid embolism. American Journal of Obstetrics & Gynecology, 183, 496-497. doi:10.1067/mob.2000.104834
 Huńka, I., Pozoga, J., Popielarz-Grygalewicz, A., Kotlarska, J. and D?browski, M. (2003) Amniotic fluid embolism in a24-year-oldfemale after caesarean section—A case report (in Polish). Kardiologia Polska, 59, 325-327.
 Hosono, K., Matsumura, N., Matsuda, N., Fujiwara, H., Sato, Y. and Konishi, I. (2011) Successful recovery from delayed amniotic fluid embolism with prolonged cardiac resuscitation. Journal of Obstetrics and Gynaecology Research, 37, 1122-1125.
 Liang, B.L. and Hong, D.H. (1992) Diagnosis and management of obstetric acute disseminated intravascular coagulation (in Chinese). Zhonghua Fu Chan Ke Za Zhi, 27, 147-148, 188.
 Abbott, P.D. and Walker, C.B.H. (1970) Amniotic fluid embolism: A syndrome of intravascular coagulation. Southern Medical Journal, 63, 1357-1360.
 Chung, A.F. and Merkatz, I.R. (1973) Survival following amniotic fluid embolism with early heparinisation. Obstetrics & Gynecology, 42, 809-814.
 Lyonnet, M.M., Saint-Arroman, J. and Banssillon, V. (1970) Un cas probable d’embolie amniotique. Guerison parl’heparinotherapie et l’epuration extra-renale. Bulletin de la Fédération des Sociétés de Gynécologie et Dóbstétrique de Langue Francaise, 22, 66.
 Masson, R.G. (1992) Amniotic fluid embolism. Clinics in Chest Medicine, 13, 657-665.
 Nishimura, K., Kawaguchi, M., Shimokawa, M., Kitaguchi, K. and Furuya, H. (1998) Treatment of pulmonary embolism during cesarean section with recombinant tissue plasminogen activator. Anesthesiology, 89, 1027-1028. doi:10.1097/00000542-199810000-00030
 Kent, K.J., Cooper, B.C., Thomas, K.W. and Zlatnik, F.J. (2003) Presumed antepartum amniotic fluid embolism. Obstetrics & Gynecology, 102, 493-495.
 Stroup, J.S., Haraway, G.D. and Beal, J.M. (2006) Aprotonin in the management of coagulopathy associated with amniotic fluid embolus. Pharmacotherapy, 26, 689-693.
 Chatelain, S.M. and Quirk Jr., J.G. (1990) Amniotic and thromboembolism. Clinical Obstetrics and Gynecology, 33, 473-481. doi:10.1097/00003081-199009000-00013
 Douketis, J.D., Berger, P.B., Dunn, A.S., Jaffer, A.K., Spyropoulos, A.C., Becker, E.C. and Ansell, J. (2008) The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 133, 299S-339S.