Successful Use of Danaparoid in Two Pregnant Women With Heart Valve Prosthesis and Heparin-Induced Thrombocytopenia Type II (HIT)

Abstract

specific fetal and maternal risks. The choice of the anticoagulant regime for mechanical heart valve thrombosis should be made by balancing 2 risksmaternal morbidity and maternal mortality-from thromboembolic complications and fetal loss and embryopathy. The risk of valve thrombosis appears to be lowest with the use of oral anticoagulants throughout pregnancy (4%); however, this increases the risk of fetal embryopathy in 6.4% of live births. Substituting oral anticoagulants with heparin reduces the risk of fetopathic effects but increases the risk of thromboembolic complications. 1A life-threatening complication of the therapy with heparin is heparin-induced thrombocytopenia type II (HIT). Heparin-induced thrombocytopenia type II is a prothrombotic condition that is associated with increased in vivo thrombin generation (as evidenced by the presence of elevated levels of thrombin-antithrombin complexes) and thus can be considered an acquired, hypercoagulability syndrome.3 Heparin-induced thrombocytopenia type II, P regnancy in women with mechanical heart valves is not benign and carries a significant risk of maternal mortality of 1% to 4%. 1,2Therapeutic anticoagulation for the prevention of thromboembolism is required throughout pregnancy in women with mechanical valve replacements, because pregnancy in women with mechanical prosthetic valves is associated with a high risk of thromboembolism, ranging from 4% to 25% despite adequate anticoagulation. 1The anticoagulants currently available include coumarin derivates, heparin, and heparin-like compounds, as well as direct thrombin inhibitors. The various therapeutic options available have their own Anticoagulant therapy with heparin for the prevention of thromboembolism in pregnant women with prosthetic heart valves is associated with an increased risk to the mother and/or the fetus. A life-threatening complication of the therapy with heparin is heparininduced thrombocytopenia type II (HIT). danaparoid has not yet been reported to be safe and effective for this indication. This study reports on a 26-year-old woman with tricuspidal valve prosthesis and a 37-yearold woman with a St. Jude Medical mitral valve prosthesis who were anticoagulated with danaparoid during pregnancy because of HIT. Anti-Xa levels were between 0.6 and 1.2 IU/mL during pregnancy with target levels of 1.0 IU/mL. Cesarean section was performed at anti-Xa levels of 0.3 and 0.7 IU/mL. One woman developed a placental hematoma at the 32nd week of gestation, which did not increase over the following week. Both patients delivered healthy boys. Heparin-induced thrombocytopenia in pregnant women with prosthetic heart valve can be successfully managed with danaparoid.

Diagnosis and management of maternal thrombocytopenia in pregnancy

“…It does not cross the placenta and is not secreted in breast milk. There are anecdotal reports of its use in pregnancy (Myers et al , ; Gerhardt et al , ). Fondaparinux is not licensed for use in HIT, but due to the ease of use and favourable outcomes of its use in HIT outside pregnancy, there are occasional reports of use in pregnancy, for women with allergy to LMWHs and, in one case of HIT, following use of unfractionated heparin in pregnancy (Ciurzynski et al , ).…”

Usefulness of Danaparoid sodium in patients with Heparin-induced thrombocytopenia after cardiac surgery

“…Both patients delivered healthy babies. [ 19 ] A comparison study of danaparoid and lepirudin in heparin-induced thrombocytopenia indicated that the efficacy of therapeutic doses of danaparoid or lepirudin in preventing death, amputation or new thromboembolic complications do not differ largely, but the risk of bleeding seems to be higher in lepirudin treated patients. [ 20 ] In this study, we investigated the usefulness of danaparoid in the treatment of HIT after cardiac surgery.…”

Argatroban therapy for heparin‐induced thrombocytopenia during pregnancy in a woman with hereditary antithrombin deficiency

“…Several cases of women who developed HIT during their pregnancies have been reported 8–11 . In these reports, HIT in pregnancy usually occurred after UFH therapies for DVT.…”

“…Several cases of women who developed HIT during their pregnancies have been reported. [8][9][10][11] In these reports, HIT in pregnancy usually occurred after UFH therapies for DVT. Only one report showed a cause of DVT in pregnancy as homozygous factor V Leiden mutations.…”