Low molecular weight heparin (dalteparin) for the treatment of venous thromboembolism in pregnancy

Jacobsen, Anne Birgitte

doi:10.1016/s1470-0328(02)02182-1

Cited by 23 publications

(51 citation statements)

References 18 publications

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“…Similar to previous studies [1,2,5,8,17,18], we did not observe an increase in bleeding complications related to anticoagulation. Other studies have evaluated the safety of peripartum enoxaparin without directly addressing the timing of the first postpartum dose of anticoagulation.…”

Section: Discussionsupporting

confidence: 92%

“…The postpartum anticoagulation schedule was not specified. In a small observational study, Jacobsen et al [17] reported that 20 women with acute thromboembolism were treated with dalteparin during pregnancy until active labor. Therapeutic doses of dalteparin (105-125 U/kg twice daily) were restarted 3-4 h postpartum for vaginal deliveries, and no bleeding complications were recorded.…”

Section: Discussionmentioning

confidence: 99%

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Timing of postpartum enoxaparin administration and severe postpartum hemorrhage

Freedman¹,

Bauer

Neuberg

et al. 2008

Blood Coagulation &Amp; Fibrinolysis

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The appropriate time to restart anticoagulation in the postpartum period is not known. The purpose of the present study was to determine whether the timing of postpartum enoxaparin influences hemorrhagic outcomes. A total of 95 women were treated with peripartum enoxaparin and compared with 303 consecutive deliveries where anticoagulation was not administered. The overall rate of severe postpartum hemorrhage did not differ significantly for women treated with peripartum enoxaparin (4.2%) versus nonanticoagulated control individuals (2.0%, P = 0.40) nor for the subgroup of women who underwent vaginal delivery (3.6 versus 1.4%, P = 0.55) or cesarean section (5.1 versus 3.4%, P = 0.98). We did not observe any severe hemorrhagic events attributable to administration of postpartum enoxaparin. The first dose of enoxaparin was administered less than 24 h following delivery in 75% of vaginal deliveries and in 49% of cesarean sections where enoxaparin was given in the postpartum period. Two incisional hematomas were observed in the group of women who received enoxaparin within 24 h following cesarean section. Severe postpartum hemorrhage is an infrequent complication when enoxaparin is administered to hemostatically intact women between 5 and 24 h following a vaginal delivery or 12-36 h following cesarean section.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Timing of postpartum enoxaparin administration and severe postpartum hemorrhage

Freedman¹,

Bauer

Neuberg

et al. 2008

Blood Coagulation &Amp; Fibrinolysis

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“…LMWHs undergo less binding to heparin-binding proteins than unfractionated heparin, but the increased clearance and degradation are likely to decrease the effectiveness of the dose. Jacobsen et al (47) found that pregnant women may require dalteparin dose increases of 10 -20% compared with nonpregnant women in order to reach a target anti-Xa activity. Barbour et al (37) found that standard weight-based therapeutic doses of dalteparin, dosed every 12 hrs, were inadequate to maintain therapeutic range anticoagulation based on target anti-Xa levels.…”

Section: Diagnosis Of Dvtmentioning

confidence: 99%

Pulmonary embolism during and after pregnancy

Stone

Morris²

2005

Critical Care Medicine

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“…The need for dose adjustments remains controversial. Small studies suggest that increasing LMWH doses are required to maintain anti-Xa levels in the expected therapeutic range [46,47], whereas other experts point to the relatively wide therapeutic window for LMWHs, making dose adjustments unnecessary unless excessive changes in weight occur [48].…”

Section: Therapeutic Dose Lmwhmentioning

confidence: 99%

Using low molecular weight heparin in special patient populations

Lim

2009

J Thromb Thrombolysis

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Clinical trials evaluating low molecular weight heparin (LMWH) for the prevention and treatment of venous thromboembolism and acute coronary syndromes have led to their regulatory approval for these indications in the general population. However, certain patient populations have been excluded from these landmark clinical trials, including patients with renal insufficiency, obese patients and pregnant women. In these special populations, data on safety and efficacy is limited and typically based on pharmacokinetic studies often performed in healthy subjects, or small cohort studies which are generally not powered to evaluate clinical outcomes such as bleeding or recurrent thrombosis. Because LMWH is mainly cleared renally, patients with severe renal insufficiency are at risk of LMWH accumulation and increased bleeding risks. In obese patients, there is concern regarding possible overdosing of therapeutic dose LMWH, since LMWH does not distribute in fat tissue. There are also concerns about possible underdosing of prophylactic dose LMWH in obese individuals using the standard fixed doses, particularly in the extremely obese individuals undergoing bariatric surgery. Last, pregnancy poses challenges with regards to the safety of LMWH during pregnancy and use of LMWH around delivery. This review summarizes the existing data in these special populations and proposes general recommendations for practice.

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Low molecular weight heparin (dalteparin) for the treatment of venous thromboembolism in pregnancy

Cited by 23 publications

References 18 publications

Timing of postpartum enoxaparin administration and severe postpartum hemorrhage

Timing of postpartum enoxaparin administration and severe postpartum hemorrhage

Pulmonary embolism during and after pregnancy

Using low molecular weight heparin in special patient populations

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