Coagulation Parameters in Pregnancy: Low-Molecular-Weight Heparin Prophylaxis in Women with Thrombophilic Risk Factors

Venous thromboembolism occurs approximately in 1 of 1000 pregnancies. It is one of the leading causes of maternal mortality. Physiologic changes associated with pregnancy and delivery favor for developing venous thromboembolism, and there are individual risk factors, too, contributing to its manifestation. The most frequent risk factors of venous thromboembolism developing during pregnancy are the previous venous thromboembolism and the thrombophilias, furthermore, some other diseases and some unique complications of pregnancy and delivery. Beyond mechanical prevention only heparin preparations can be used for preventing and treating venous thromboembolism in pregnancy and among them the low-molecular-weight heparins are preferred for applying. Dosage of low-molecular-weight heparin preparations is determined by the type and strength of thrombophilia. For treatment of venous thromboembolism presented during pregnancy subcutaneous 100 IU/kg low-molecular-weight heparin is generally used at every 12 hours. Postpartum the oral anticoagulants can be safely applied, too. Orv. Hetil., 2011, 152, 815–821.

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Point of care ultrasound (POCUS) in diagnosis of proximal deep vein thrombosis among COVID-19 hospitalized patients with a high rate of low molecular weight heparin prophylaxis

Medicina Clínica ◽

10.1016/j.medcli.2021.01.012 ◽

2021 ◽

Author(s):

Pedro M. García-Ceberino ◽

Naya Faro-Míguez ◽

Francisco Javier Beltrán-Ávila ◽

Daniel Fernández-Reyes ◽

Inmaculada Gallardo-Muñoz ◽

...

Keyword(s):

Molecular Weight ◽

Deep Vein Thrombosis ◽

Low Molecular Weight Heparin ◽

Point Of Care ◽

High Rate ◽

Low Molecular Weight ◽

Point Of Care Ultrasound ◽

Vein Thrombosis ◽

Deep Vein ◽

Heparin Prophylaxis

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Evaluation and Management of Women who Have Experienced Stillbirth in Their Previous Pregnancies

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.892 ◽

2019 ◽

pp. 1

Author(s):

Erdem Fadiloglu ◽

Atakan Tanacan ◽

Canan Unal ◽

Mehmet Sinan Beksac

Keyword(s):

Risk Factors ◽

Molecular Weight ◽

Low Molecular Weight Heparin ◽

Low Dose ◽

Methylenetetrahydrofolate Reductase ◽

Post Partum ◽

Subsequent Pregnancy ◽

Low Molecular Weight ◽

Mthfr Polymorphisms ◽

The Mean

Objective: To evaluate the subsequent pregnancy outcomes of women who have experienced unexplained stillbirth in their previous gestations.Study Design: This retrospective cohort consisted of 14 pregnancies who had stillbirth (without known risk factors) in their previous pregnancies. These patients had been included in a special preconceptional care program to be evaluated in terms of etiological risk factors for stillbirth. At least one of the risk factors, such as methylenetetrahydrofolate reductase (MTHFR) polymorphisms, hereditary thrombophilias and autoimmune problems, were defined in this study population. After detection of pregnancy, the patients were administered low-dose low-molecular-weight heparin (LMWH) (enoxaparin, 1×2000 Anti-XA IU/0.2 mL/day), low-dose salicylic acid (100 mg/day) and low-dose corticosteroid (methylprednisolone, 1×4 mg/day orally) in necessary cases.Results: Out of 14 pregnancies, 4 (28.5%) ended up with miscarriages at 9, 11, 11 and 15 gestational weeks, respectively. The remaining 10 pregnancies ended up with alive deliveries. The mean gestational week at birth was 36.4±0.51, while the mean birthweight was 2882±381.01 g. Out of 10 pregnancies, only one was diagnosed as IUGR. Only two newborn necessitated hospitalization in the neonatal intensive care unit (NICU) due to respiratory problems. Both newborns were discharged from the NICU without any further complication at the post-partum 5th day. Conclusion: Patients with a prior stillbirth should be screened for MTHFR polymorphisms, autoimmune problems and hereditary thrombophilias, especially in case of absence of any etiological factor. Management of these patients with low-dose aspirin, low-dose low molecular weight heparin and corticosteroids seemed to be beneficial for increasing live birth rates and avoiding obstetric complications.

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Thrombosis and embolism in pregnancy

Oxford Textbook of Obstetrics and Gynaecology ◽

10.1093/med/9780198766360.003.0016 ◽

2020 ◽

pp. 206-212

Author(s):

Ian A. Greer

Keyword(s):

Molecular Weight ◽

Low Molecular Weight Heparin ◽

Objective Assessment ◽

Fold Increase ◽

Low Molecular Weight ◽

Thoracic Imaging ◽

Mortality And Morbidity ◽

First Choice ◽

Daily Risk ◽

In Pregnancy

Venous thromboembolism (VTE) is a leading cause of maternal mortality and morbidity. Prophylaxis and management of VTE in pregnancy can impact mortality and morbidity. The overall reported incidence of gestational VTE ranges from 0.5 to 2.2 per 1000 maternities with a relative 5–10-fold increase in risk during pregnancy, increasing to a daily risk of 15–35-fold in the puerperium, compared with non-pregnant women of similar age. Risk factors inform the use of thromboprophylaxis usually with low-molecular-weight heparin, which has a better safety profile than unfractionated heparin. VTE can occur at any time in pregnancy, but over 50% of events occur prior to 20 weeks’ gestation. As clinical diagnosis is unreliable, objective assessment is required when there is clinical suspicion of an event. Less than 10% of clinically suspected cases of VTE are confirmed on objective testing. Compression duplex ultrasonography is the first-line investigation for suspected gestational deep venous thrombosis and thoracic imaging with ventilation–perfusion scanning is required for suspected pulmonary embolism. Low-molecular-weight heparin is usually the first choice treatment for gestational VTE based on safety and efficacy.

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