High incidence of heparin-induced allergic delayed-type hypersensitivity reactions in pregnancy

Schindewolf, Marc; Gobst, Corinna; Kroll, Hartmut; Recke, Andreas; Louwen, Frank; Wolter, M.; Kaufmann, Roland; Boehncke, Wolf‐Henning; Lindhoff-Last, Edelgard; Ludwig, Ralf J.

doi:10.1016/j.jaci.2013.02.047

Cited by 39 publications

(51 citation statements)

References 40 publications

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“…Interestingly, we found that the incidence of heparin‐induced skin lesions during LMWH treatment was considerably lower in orthopedic surgery patients compared with different previously assessed patient cohorts. More specifically, the incidence we registered was 1.9% (95% CI: 0.4%‐3.4%) in orthopedic patients compared to 7.5% in medical patients and 19.8% in obstetric patients . All lesions were diagnosed clinically and histologically—by the detection of a lymphohistiocitary infiltrate and the absence of microthromboses in dermal vessels—as a DHT reaction.…”

Section: Discussionmentioning

confidence: 76%

“…However, these patient‐related risk factors seem to play a lesser role in orthopedic surgery patients than in medical or obstetric patients. Regarding heparin preparation‐related risk factors, nadroparin showed no significantly increased risk for sensitization in surgical patients, while previous studies found a strong correlation (OR 30) . One suitable alternative may be the pentasaccharide fondaparinux.…”

Section: Discussionmentioning

confidence: 84%

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Low incidence of heparin‐induced skin lesions in orthopedic surgery patients with low‐molecular‐weight heparins

Schindewolf

Paulik

Kroll

et al. 2018

Clin Experimental Allergy

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 84%

Low incidence of heparin‐induced skin lesions in orthopedic surgery patients with low‐molecular‐weight heparins

Schindewolf

Paulik

Kroll

et al. 2018

Clin Experimental Allergy

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“…DTH reactions to heparin are clearly more common than previously believed, and have been observed in up to 20 % of women who were treated with heparins throughout pregnancy [87]. Patients usually present with an itching erythema or red plaques at the sites of heparin injections.…”

Section: Heparin-induced Allergic Skin Reactionsmentioning

confidence: 99%

Treatment of pregnancy-associated venous thromboembolism - position paper from the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Linnemann

Scholz

Rott

et al. 2016

Vasa

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Summary: Venous thromboembolism (VTE) is a major cause of maternal morbidity during pregnancy and the postpartum period. However, because there is a lack of adequate study data, management strategies for pregnancy-associated VTE must be deduced from observational studies and extrapolated from recommendations for non-pregnant patients. In this review, the members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH) have summarised the evidence that is currently available in the literature to provide a practical approach for treating pregnancy-associated VTE. Because heparins do not cross the placenta, weight-adjusted therapeutic-dose low molecular weight heparin (LMWH) is the anticoagulant treatment of choice in cases of acute VTE during pregnancy. No differences between once and twice daily LMWH dosing regimens have been reported, but twice daily dosing seems to be advisable, at least peripartally. It remains unclear whether determining dose adjustments according to factor Xa activities during pregnancy provides any benefi t. Management of delivery deserves attention and mainly depends on the time interval between the diagnosis of VTE and the expected delivery date. In particular, if VTE manifests at term, delivery should be attended by an experienced multidisciplinary team. In lactating women, an overlapping switch from LMWH to warfarin is possible. Anticoagulation should be continued for at least 6 weeks postpartum or for a minimum period of 3 months. Although recommendations are provided for the treatment of pregnancy-associated VTE, there is an urgent need for well-designed prospective studies that compare different management strategies and defi ne the optimal duration and intensity of anticoagulant treatment. Anticoagulant therapy during pregnancyLow-molecular-weight heparins (LMWH) are considered the anticoagulants of choice in pregnancy-associated VTE because LMWH do not cross the placenta and do not appear at signifi cant levels in breast milk. Although a Cochrane Review stated that there was no evidence from randomised controlled trials regarding the effi cacy of anticoagulant therapy for DVT in pregnancy [2], two systemic reviews of LMWH use in pregnant women have confi rmed their efficacy and safety, which were consistent with those in nonpregnant women [3,4]. Compared to unfractionated heparin (UFH), LMWH were associated with a substantially lower risk of adverse side eff ects, such as heparin-induced thrombocytopenia (HIT), haemorrhage, and osteoporosis [3 -7]. However, UFH may be considered an alternative if LMWH cannot be used or if UFH seems to be advantageous over LMWH, e.g., in women at high risk of bleeding complications or in women with severe renal impairment. Women with confi rmed PE and haemodynamic compromise who are candidates for subsequent thrombolysis should also receive UFH during the initial phase until defi nitive treatment decisions are reached [1]. Data obtained from non-pregnant patients have confi rmed that LMWH are at least as eff ective...

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“…Delayedtype allergic skin reactions due to administration of LMWH occur in ϳ 20% of women and were reported in 40% of women treated with nadroparin in the ALIFE study. 27,43 Finally, the use of antithrombotic therapy raises specific issues with regard to planning and induction of delivery and neuraxial anesthesia.…”

Section: Heparin To Prevent Preeclampsiamentioning

confidence: 99%

Anticoagulation in pregnancy complications

Middeldorp

2014

Hematology

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Women with acquired and inherited thrombophilia are thought to be at increased risk for pregnancy complications, including recurrent pregnancy loss and, depending on the type of thrombophilia, severe preeclampsia. This review discusses the associations between the types of thrombophilia and types of complications, as well as the currently available clinical trial evidence regarding the use of aspirin and heparin to prevent these pregnancy complications. In women with antiphospholipid syndrome, guidelines recommend prescribing aspirin and heparin to women with recurrent miscarriage. The same regimen is suggested for late pregnancy complications by some, but not all, experts. Aspirin or low-molecular-weight heparin to improve pregnancy outcome in women with unexplained recurrent miscarriage has no benefit and should not be prescribed. Whether anticoagulant therapy prevents recurrent miscarriage in women with inherited thrombophilia or in women with severe pregnancy complications remains controversial because of inconsistent results from trials. Aspirin modestly decreases the risk of severe preeclampsia in women at high risk. Learning Objectives• To describe the association between pregnancy complications and thrombophilia both quantitatively and qualitatively • To describe the state of the evidence with respect to prevention of pregnancy complications with aspirin and/or heparin in various subgroups of women, particularly women with antiphospholipid syndrome and those with inherited thrombophilia

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High incidence of heparin-induced allergic delayed-type hypersensitivity reactions in pregnancy

Cited by 39 publications

References 40 publications

Low incidence of heparin‐induced skin lesions in orthopedic surgery patients with low‐molecular‐weight heparins

Low incidence of heparin‐induced skin lesions in orthopedic surgery patients with low‐molecular‐weight heparins

Treatment of pregnancy-associated venous thromboembolism - position paper from the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Anticoagulation in pregnancy complications

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