The use of LMWH in pregnancies at risk: new evidence or perception?

Greer, Ian A.

doi:10.1111/j.1538-7836.2005.01298.x

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…The need for level I evidence to guide clinical practice has been described as ''urgent and unequivocal.'' 42 Clinicians and patients have perceived the need for such trials for many years; however, despite several attempts, few RCTs that address the above questions have been completed. The primary reason for this is that implementation and recruitment of women to a randomized trial that involves a daily, injectable drug in pregnancy is very difficult.…”

Section: Suggested Management Of Thrombophilic Pregnanciesmentioning

confidence: 99%

Do Thrombophilias Cause Placenta-Mediated Pregnancy Complications?

Rodger¹,

Paidas²

2007

Semin Thromb Hemost

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There has been an sudden increase of knowledge about thrombophilias in the last decade as new thrombophilias are discovered and new associations are explored. It is now evident that thrombophilias are common and that the clinical consequences of having a thrombophilia do not appear to be limited to venous thromboembolism. The placenta-mediated pregnancy complications are also common (more than one in six pregnancies are affected) and include pregnancy loss, preeclampsia, placental abruption, and intrauterine growth restriction. These complications as a whole are the leading causes of maternal and neonatal morbidity in the developed world. Evidence has emerged to suggest that thrombophilic women may be at higher risk of developing these placenta-mediated pregnancy complications. However, is this evidence mature enough to claim that a causal association is proven? Is the evidence strong enough to recommend anticoagulant prophylaxis? We suggest that causality is not yet proven and that the data to support management with anticoagulant prophylaxis in thrombophilic pregnancies is too immature to consider this an established intervention.

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Section: Suggested Management Of Thrombophilic Pregnanciesmentioning

confidence: 99%

Do Thrombophilias Cause Placenta-Mediated Pregnancy Complications?

Rodger¹,

Paidas²

2007

Semin Thromb Hemost

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“…No definitive treatment exists, but antithrombotic therapy offers some hope. This treatment has evolved from the treatment of RPL associated with antiphospholipid syndrome (APAS) [62][63][64][65]. Individual reports linking thrombophilia to RPL are variable due to differences in populations, definitions, and timing of RPL [66], but metaanalyses clearly support the association between RPL and heritable thrombophilias, particularly Protein C and S deficiencies, Factor V Leiden and Prothrombin G20210A [5,6,67].…”

Section: Prevention Of Pregnancy Complications In Women With Thrombopmentioning

confidence: 97%

Anticoagulants in Pregnancy

Greer

2006

J Thromb Thrombolysis

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Venous thromboembolic (VTE) complications are a leading cause of maternal mortality in the developed world. To reduce the incidence of VTE in pregnancy, and improve outcomes, a wider understanding of the risk factors involved and a better identification of women at risk of thrombosis coupled with effective thromboprophylaxis and treatment of VTE are required. As coumarin is unsuitable for use in pregnancy because of problems with embryopathy and risk of fetal bleeding, anticoagulation therapy in pregnancy centres on the use of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH). There is now extensive experience of the safety and efficacy of LMWH in pregnancy. LMWH's, such as enoxaparin and dalteparin, have clinical and practical advantages compared with UFH in terms of improved safety (significantly lower incidence of osteoporosis and heparin induced thrombocytopenia), and patient convenience with once daily dosing for the majority of women. Such therapy is not restricted only to prevention and treatment of VTE but is now being assessed in additional clinical situations such as the prevention of pregnancy complications.

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“…While significant progress has been made in the treatment of women with gestational vascular complications, ideally large, placebo-controlled trials should be advocated [46]. However, there are logistical and ethical difficulties that limit enrollment in such studies [47,48]. In view of the hesitance of the industry to perform of large trials in pregnancy, such studies will probably need support from healthcare institutions.…”

Section: Safety Of Lmwhmentioning

confidence: 99%

Enoxaparin Use in Pregnancy: State of the Art

Brenner

2007

Womens Health (Lond Engl)

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Low-molecular-weight heparin is the anticoagulant of choice in pregnancy. Enoxaparin has been increasingly used over the past 20 years in pregnant women at risk of thrombosis and pregnancy complications. The main indications are prophylaxis of venous thromboembolism and prevention of pregnancy loss in thrombophilic women. Other indications include treatment of venous thromboembolism, prophylaxis of arterial thrombosis in pregnant women with mechanical heart valves and prevention of late gestational complication such as pre-eclampsia and intrauterine growth restriction. Enoxaparin does not cross the placenta and is safe for the fetus. Maternal side effects are uncommon and include mild localized allergic reactions in 2% and increased bleeding in 2%, which is dose dependent. Heparin-induced thrombocytopenia is very rare and bone resorption is not clinically relevant. The mechanisms of action of enoxaparin in pregnancy are multiple and include anti-factor Xa (anti-Xa) activity in maternal circulation, tissue factor pathway inhibitor release from endothelial cells and trophoblasts at the placental level as well as anti-inflammatory effects.

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The use of LMWH in pregnancies at risk: new evidence or perception?

Abstract: Purists or pragmatists: how do clinicians manage the mixed messages on miscarriage and thromboprophylaxis?

Cited by 6 publications

References 14 publications

Do Thrombophilias Cause Placenta-Mediated Pregnancy Complications?

Do Thrombophilias Cause Placenta-Mediated Pregnancy Complications?

Anticoagulants in Pregnancy

Enoxaparin Use in Pregnancy: State of the Art

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