Safety and Efficacy of Low Molecular Weight Heparin Therapy During Pregnancy: Three Year Experience at a Tertiary Care Center

Abstract

Purpose To evaluate safety and efficacy of low molecular weight heparin given for various indications during pregnancy. Methodology A detailed retrospective analysis of all the patients who received low molecular weight heparin (LMWH) for various indications over a period of 3 years (2010)(2011)(2012) at a tertiary care hospital in Northern India was performed. Results Fifty-five patients received LMWH over the period of 3 years, for various indications. Enoxaparin (1 mg/kg body weight OD/BD subcutaneously) was used. The indications were valvular heart disease with valve replacement, atrial fibrillation, or thrombus in 60 % patients; chronic deep vein thrombosis (DVT) in 7 % patients; thrombophilia in 9.1 % patients; recurrent pregnancy losses in 18 % patients; and DVT prophylaxis in 5.5 % patients. Abortion was seen in 7.2 % patients; fetal growth restriction in 10.9 % patients; and oligohydramnios, preeclampsia, gestational hypertension, placenta previa, abruptio placentae, and postpartum hemorrhage in 1.8 % patients. Stillbirth occurred in 3.6 % patients. No thromboembolic event was noted in any of the patients. None of the patients had any documented thrombocytopenia or clinical fracture. Conclusion Low molecular weight heparin can be used in pregnancy for various indications as an alternative to unfractionated heparin or warfarin as it is efficacious and safe.

Pregnancy outcome in women with mechanical prosthetic heart valvesat their first trimester of pregnancy treated with unfractionated heparin (UFH) or enoxaparin: a randomized clinical trial

“… 14 In contrast, recent studies have indicated that LMWH is safe for pregnant women using anticoagulants when it is used with anti-Xa assey. 6 , 12 Therefore, monitoring of the maximum anticoagulant activity using anti-Xa levels is currently recommended to ensure the safety of anticoagulation therapy with LMWH. 2 …”

“…Many studies have also examined the maternal and fetal complications that are caused by the use of these two types of heparin; however, a definitive conclusion regarding the induced complications has not been achieved yet. 6 - 8 …”

SINGLE CENTRE, OPEN-LABEL & NON RANDOMIZED CLINICAL TRIAL TESTING LMWH EFFICACY ON PERINATAL OUTCOME INLATE SECOND TRIMESTER OLIGOHYDRAMNIOS CASES

“…Low molecular weight heparin (LMWH) has shown a promising results in oligohydramnios cases. Low molecular weight heparin fractions were first prepared by fractionation of the crude unfractionated heparin during 1970-1980 3 . Fractionated Heparin has was more advantageous than its un-fractionated counterpart.…”

Congenital fulminant Kaposiform hemangioendothelioma of the leg

“…We present a case of congenital fulminant KH of the leg that was born to a mother treated with polytherapy for rheumatoid arthritis including prednisone, hydroxychloroquine and etanercept during her pregnancy. Prednisone, hydroxychloroquine [2] and enoxaparine [3] are commonly prescribed and can be safely used during pregnancy, however data concerning maternal etanercept treatment during pregnancy are limited.…”