Long-Term Therapy with Subcutaneous Heparin during Pregnancy

Hellgren, Margareta; Nygårds, Eva-Britt

doi:10.1159/000299488

Cited by 59 publications

(15 citation statements)

References 15 publications

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“…Two reported on pregnancy outcomes in cohorts of women with AT deficiency,32,33 one reported on the prevalence of AT deficiency among women with pregnancy-related VTE,34 and a number of case series and case reports have reported specifically on the course and treatment during pregnancy of women with AT deficiency27,28,32–45 (Table 2). Different regimens have been used for antepartum and peripartum thromboprophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Prevention and treatment of venous thromboembolism in pregnancy in patients with hereditary antithrombin deficiency

James¹,

Konkle²,

Bauer

2013

IJWH

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ObjectiveThe aims of the study reported here were to provide data from six pregnant subjects who were enrolled in a clinical trial of antithrombin (AT) concentrate, discuss other published case series and case reports, and provide general guidance for the use of AT concentrate for inherited AT deficiency in pregnancy.MethodsIn the late 1980s, 31 AT-deficient subjects were enrolled in a prospective treatment trial of the plasma-derived AT concentrate Thrombate III®. Herein, newly available treatment data about the six pregnant subjects in the trial is tabulated and summarized.ResultsAll six experienced venous thromboembolism (VTE) during pregnancy, were dosed according to a weight-based protocol, and were treated concomitantly with anticoagulation. Loading doses of AT concentrate of 54–62 units/kg were followed by maintenance doses of 50%–100% of the loading dose for 3–10 days. At the time of labor, loading doses of 46–50 units/kg were followed by maintenance doses of 50%–75% of the loading dose for 5–7 days. None of the six experienced recurrent thrombosis while receiving treatment with AT concentrate.ConclusionCurrently we suggest that women with AT deficiency who are pregnant or postpartum and have a personal history of VTE or current VTE receive AT concentrates.

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Section: Discussionmentioning

confidence: 99%

Prevention and treatment of venous thromboembolism in pregnancy in patients with hereditary antithrombin deficiency

James¹,

Konkle²,

Bauer

2013

IJWH

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“…Heparin-associated osteoporosis is a rare but potentially serious complication of unfractionated heparin (UFH) and LMWH therapy. Most of the reported cases of symptomatic osteoporosis with spontaneous fractures occurred in pregnant women treated with UFH for recurrent thromboembolism [2,3].…”

Section: Introductionmentioning

confidence: 99%

Changes in Bone Density during Long-Term Administration of Low-Molecular-Weight Heparins or Acenocoumarol for Secondary Prophylaxis of Venous Thromboembolism

Wawrzyńśka¹,

Tomkowski²,

Przedlacki

et al. 2003

Pathophysiol Haemos Thromb

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Background: Indications for long-term anticoagulation are expanding. Osteoporosis is a complication which can develop after prolonged treatment with unfractionated heparin and is probably multifactorial. Data on osteoporosis associated with low-molecular-weight heparins (LMWH) are contradictory. Vitamin K participates in bone metabolism and since oral anticoagulants antagonize vitamin K, their use may also increase the risk of osteoporosis. Aim: To assess and compare the effects of long-term secondary venous thromboembolic prophylaxis with LMWH or acenocoumarol on bone structure. Methods: We assessed bone mineral density (BMD) by densitometry in 86 patients receiving LMWH or acenocoumarol for 3–24 months. The initial BMD was compared to the final result expressed as the percentage difference. The Z-score was also assessed and defined for individual patients as the number of standard deviations of BMD from its ideal value calculated for age and sex groups. Results: Excessive decrease in BMD was evidenced, which seemed to relate to the duration as well as type of treatment. At 1 and 2 years of follow-up, the mean decrease in BMD of the femur was 1.8% and 2.6% in patients on acenocoumarol and 3.1 and 4.8% in patients on enoxaparin, respectively. Conclusions: Long-term exposure to treatment and prophylaxis of venous thromboembolism cause a modest but progressive decrease in BMD, more evident in patients on LMWH than on acenocoumarol. It might be advisable to perform densitometry before starting long-term anticoagulation and to repeat it every 12 months, especially in patients with concomitant risk factors for osteoporosis in order to identify patients in need of its prophylaxis.

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“…The large heparin molecule does not pass the placenta barrier, and heparin will accordingly not appear in the fetal blood (57). However, for long term therapy with large doses of heparin during pregnancy the risk of inducing osteoporosis in the mother has to be considered (1,79,171,204).…”

Section: F Berglund Et Almentioning

confidence: 99%

Drug use During Pregnancy and Breast‐Feeding: A classification sytem for drug information

Berglund

Flodh

Lundborg

et al. 1984

Acta Obstet Gynecol Scand

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Since 1978 the Swedish catalogue of registered pharmaceutical specialities (FASS) has carried a special section entitled “Pregnancy and breast‐feeding” in each product presentation, intended to form an aid for the prescription of drugs to women during child‐bearing and lactation. After a brief review of transplacental transport and milk secretion, reproduction‐toxicology studies in animals, and methods for clinical evaluation of drugs for use during pregnancy, the classification system is presented. On the basis of available data with regard to effects on early and late stages of pregnancy and labour, all the pharmaceutical specialities concerned are assigned to one of the following pregnancy categories: A, B 1, B 2, B 3, C or D. The letters refer to information based on findings in man, and the figures to information based on animal data. For drugs in categories B 3, C or D any harmful effects observed or likely to occur in man or animals are to be specified. The pregnancy categories are defined as follows: Category A. Drugs which may be assumed to have been used by a large number of pregnant women and women of child‐bearing age, without any form of definite disturbance in the reproductive process having been noted so far, e.g. an increased incidence of malformations or other direct or indirect harmful effects on the fetus. Category B. Drugs which may be assumed to have been used by only a limited number of pregnant women and women of child‐bearing age, without any form of definite disturbance in the reproduction process having been noted so far, e.g. an increased incidence of malformations or other direct or indirect harmful effects on the fetus. Category C. Drugs which by their pharmacological effects have caused, or must be suspected of causing disturbances in the reproduction process that may involve risk to the fetus without being directly teratogenic. Category D. Drugs which have caused an increased incidence of fetal malformations or other permanent damage in man or which on the basis of e.g. reproduction‐toxicology studies must be suspected of doing so. This category comprises drugs with primary teratogenic effects. If the drug also has pharmacological effects that may directly or indirectly have a harmful effect on the fetus, this must also be stated. As experience of effects of drugs in Category B is limited, results of reproduction‐toxicology studies in animals are indicated by allocation to one of three subgroups according to the following definitions: Category B 1. Reproduction‐toxicology studies have not given evidence of an increased incidence of fetal damage or other deleterious effects on the reproduction process. Category B 2. Reproduction‐toxicology studies are inadequate or may be lacking, but available data reveal no evidence of an increased incidence of fetal damage or other deleterious effects on the reproduction process. Category B 3. Reproduction‐toxicology studies have revealed an increased incidence of fetal damage or other deleterious effects on the reproduction process, the significa...

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Long-Term Therapy with Subcutaneous Heparin during Pregnancy

Cited by 59 publications

References 15 publications

Prevention and treatment of venous thromboembolism in pregnancy in patients with hereditary antithrombin deficiency

Prevention and treatment of venous thromboembolism in pregnancy in patients with hereditary antithrombin deficiency

Changes in Bone Density during Long-Term Administration of Low-Molecular-Weight Heparins or Acenocoumarol for Secondary Prophylaxis of Venous Thromboembolism

Drug use During Pregnancy and Breast‐Feeding: A classification sytem for drug information

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