Thromboprophylaxis with Low Molecular Weight Heparin (Fragmin) in High Risk Pregnancies

1997 ◽  
Vol 77 (01) ◽  
pp. 039-043 ◽  
Author(s):  
Beverley J Hunt ◽  
Heidi-Ann Doughty ◽  
G Majumdar ◽  
Adrian Copplestone ◽  
Sian Kerslake ◽  
...  
Keyword(s):  
Molecular Weight ◽  
High Risk ◽  
Post Partum ◽  
Osteoporotic Fractures ◽  
First Trimester ◽  
Thromboembolic Disease ◽  
Low Molecular Weight ◽  
Optimal Dosage ◽  
High Risk Women ◽  
Osteoporotic Vertebral Collapse

SummaryVenous thromboembolic disease remains the commonest cause of maternal death. The management of thromboprophylaxis in high risk women during pregnancy is contentious. Low molecular weight heparins (LMW) have theoretical advantages compared with unfractionated heparin and warfarin but have been poorly studied in pregnancy. We report on the use of LMW heparin (Fragmin) as thromboprophylaxis in thirty four high risk pregnancies.All the women had a previous thrombosis or a thrombosis in their current pregnancy +/- a recognised thrombophilic state (eleven had the antiphospholipid syndrome).Fragmin was given subcutaneously to maintain trough anti-Xa activity of 0.15-0.2 U/ml and 2 h post injection levels of 0.4-0.6 U/ml. The levels were checked monthly during pregnancy. Most women required 5,000U Fragmin once daily during the first trimester unless they were greater than 100 kg at the start of pregnancy. The mean time for dosage increase was 20.5 week (S.D. 8.2). 26/34 pregnancies (76%) required twice daily at the end of pregnancy. Epidural anaesthesia was managed by omitting Fragmin dose or inserting the needle 6 hours after the previous Fragmin injection. There were no thromboembolic events, thrombocytopenias or excessive haemorrhage. One woman had osteoporotic vertebral collapse post partum, she had no other risk factors for osteoporosis.LWM heparin (Fragmin) appears to be efficacious in preventing recurrent thromboembolic disease in pregnant women at high risk, but it is notable that osteoporotic fractures occurred post partum in one woman. Further trials are required to determine optimal dosage and safety.

scholarly journals Patterns of antenatal care in low-versus high-risk pregnancies in Lebanon

2004 ◽  
Vol 10 (3) ◽  
pp. 268-276
Author(s):  
F. El Kak ◽  
M. Chaaya ◽  
O. Campbell ◽  
A. Kaddour
Keyword(s):  
High Risk ◽  
Antenatal Care ◽  
Laboratory Tests ◽  
Risk Groups ◽  
First Trimester ◽  
Pregnancy Risk ◽  
High Risk Women ◽  
Special Diets ◽  
Number Of Visits ◽  
Antenatal Visits

Westudied patterns of antenatal care in low- versus high-risk pregnancies in Lebanon comparing 538 women after delivery in urban Beirut with rural Baka’a. Most women had 9 antenatal care visits with an obstetrician, starting in the first trimester. Care for high-risk and low-risk pregnancies was similar in terms of type of provider, number of visits and timing of first visit. More high-risk women had advice about special diets, supplements and laboratory tests. Maternal and fetal outcomes showed that, controlling for area and pregnancy risk, more antenatal visits were associated with fewer preterm deliveries, more caesarean sections and fewer cases of postpartum depression. Overall, differences between risk groups were small

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

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

<p><strong>Objective:</strong> To evaluate the subsequent pregnancy outcomes of women who have experienced unexplained stillbirth in their previous gestations.</p><p><strong>Study Design:</strong> 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.</p><p><strong>Results:</strong> 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. </p><p><strong>Conclusion:</strong> 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.</p>

Cancer and Coagulopathy

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Molecular Weight ◽  
Advanced Cancer ◽  
Arterial Thrombosis ◽  
Poor Prognosis ◽  
Antiplatelet Agents ◽  
Thromboembolic Disease ◽  
Low Molecular Weight ◽  
Preventative Therapy ◽  
Cardiac Valves ◽  
Low Molecular Weight Heparins

Advanced cancer is well known to cause a procoagulant state. The formation of sterile platelet thrombin vegetations on cardiac valves (i.e., nonbacterial thromboembolic disease) and arterial thrombosis are common etiologies of stroke in these patients. Despite preventative therapy with antiplatelet agents or low-molecular-weight heparins, stroke in cancer often portends a poor prognosis.

The Low-Molecular-Weight-Heparin, Tinzaparin, Is Effective and Safe in the Treatment and Prophylaxis of Venous Thromboembolic Disease during Pregnancy.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1774-1774 ◽  
Author(s):  
Maja Jorgensen ◽  
Jorn D. Nielsen
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Pregnant Women ◽  
University Hospital ◽  
Individual Risk ◽  
Low Molecular Weight ◽  
Venous Thromboembolic ◽  
Individual Risk Assessment

Abstract During pregnancy the incidence of venous thromboembolism (VTE) is approximately 6 times higher than in age-matched, non-pregnant women and venous thromboembolism remains the most common cause of maternal morbidity and mortality. Low-molecular-weight-heparins are recommended for treatment of VTE during pregnancy and for prophylaxis of VTE in pregnant women with major thromboembolic risk factors. We used tinzaparin for prophylaxis and treatment of VTE in 305 consecutive pregnant women referred to the Thrombosis Centre, Gentofte University Hospital, from 1997 to 2004. In 268 pregnancies the mothers had thrombophilia, 52 women were admitted with acute VTE and 184 had previous VTE. Other clinical risk factors included previous bad obstetric outcome, recurrent miscarriages, cardiac disorders or previous thromboembolic stroke. An individual risk assessment of each pregnant woman was performed. Very high risk females were treated with tinzaparin 90 – 100 IU/kg bid, high risk females were treated with tinzaparin 100 – 125 IU/kg daily and women with moderate risk were treated with 50 – 75 IU/kg daily. 302 of 305 pregnancies (99 %) in 263 females resulted in 310 healthy babies. 306 of 310 babies had appropriate birth weight for gestational week and all babies had normal Apgar score. Two females had miscarriages (week 10 and 20) and 1 female had an elective abortion. No females had pulmonary embolism. Deep venous thrombosis occurred in 4 of 305 pregnancies = 1,3 % (week 6, 11, 27 and one day postpartum). Wound hematoma was observed after cesarean section in two women and postpartum bleeding episodes (700 – 1500 ml) were observed in 7 women (4 had severe vaginal or cervical tearings, 2 had retained placenta and 1 had placental abruption). We found no incidence of thrombocytopenia or symptomatic osteoporosis. We find that individually dosed tinzaparin is safe and seems effective in the prevention of thromboembolic complications during pregnancy. Individual risk stratification is recommended.

Cancer Patients Requiring Interruption of Long-Term Anticoagulant Therapy: The Use of Fixed Sub-Therapeutic Doses of Low-Molecular Weight Heparin

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1244-1244
Author(s):  
Giorgia Saccullo ◽  
Alessandra Malato ◽  
Lucio Lo Coco ◽  
Ilenia Barbello ◽  
Clementina Caracciolo ◽  
...  
Keyword(s):  
Molecular Weight ◽  
High Risk ◽  
Cancer Patients ◽  
Low Molecular Weight Heparin ◽  
Risk Group ◽  
Low Risk ◽  
Major Surgery ◽  
Low Molecular Weight ◽  
Therapeutic Doses ◽  
Risk For Thrombosis

Abstract Abstract 1244 Introduction. We tested the efficacy and safety of fixed doses of Low-Molecular Weight Heparin (LMWH) in cancer patients requiring interruption of Vitamin-k Antagonist (VKA) because of invasive procedures (defined as major and non major surgery) or chemotherapy inducing platelets depletion. Methodology. Cancer patients were defined to be at high (atrial fibrillation [AF] with previous stroke, prosthetic mitralic valves and venous thromboembolism [VTE] lasting < 3months) or low risk of thrombosis (AF without previous stroke, VTE lasted > 3 months, and prosthetic aortic valves). They discontinued VKA 5 + 1days before surgery or chemotherapy; in those at low-risk for thrombosis, LMWH was given at a prophylactic dosage of 3.800 U.I. (nadroparin) or 4.000 U.I. (enoxaparin) anti-FXa once daily the night before the procedure or the beginning of chemotherapy. In patients at high-risk for thrombosis, LMWH was started early after VKA cessation (when an INR < 1.5) and given at fixed sub-therapeutic doses (3.800 or 4.000 UI anti-FXa twice daily) until procedure or beginning of chemotherapy. In patients undergoing procedures, LMWH was reinitiated 12 hours after procedure while VKA the day after; in patients receiving chemotherapy, LMWH was reinitiated 12 h after a stable platelet count > 30.000 mmc3 and VKA 12 h after a stable platelet count > 50.000 mmc3. Heparin was continued until a therapeutic INR value was reached. The primary efficacy endpoints were the incidence of thromboembolism and major bleeding from VKA suspension to 30 + 2 days post-procedure or next chemotherapy. Results. A total of 156 patients (68, 53.9% at low-risk and 58, 46.1% at high-risk for thrombosis) were enrolled (Table 1); 44 (28.2%) underwent major surgery, 53 (33.9%) non-major surgery and 29 (18.5%) chemotherapy. Overall, thromboembolic events occurred in 5 patients (3.2%, 95% confidence intervals 0.5–5.9), 4 belonging to high-risk and 1 to low-risk group. Overall, major bleeding occurred in 5 patients (3.2%, 95 CI 0.5–5.9), all belonging to high-risk group (3 during major surgery and 2 during chemotherapy). The mean time of anticoagulation with LMWH was 7.5 days in patients underwent procedures and 13.2 days in those who received chemotherapy. Conclusion. LMWH given at fixed sub-therapeutic doses appears to be a feasible and relatively safe approach for bridging therapy in chronic anticoagulated cancer patients requiring VKA interruption. Disclosures: No relevant conflicts of interest to declare.

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