Thromboprophylaxis with low-molecular-weight heparin after cesarean delivery

2010 ◽  
Vol 103 (01) ◽  
pp. 129-137 ◽  
Author(s):  
Arnaud Perrier ◽  
Mathieu Nendaz ◽  
Marc Righini ◽  
Francoise Boehlen ◽  
Michel Boulvain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Life Expectancy ◽  
Cesarean Delivery ◽  
Low Molecular Weight Heparin ◽  
Developed Countries ◽  
Sensitivity Analyses ◽  
Low Molecular Weight ◽  
Level Of Evidence ◽  
Quality Adjusted Life

SummaryAlthough venous thromboembolism (VTE) is the leading cause of maternal mortality in developed countries, the usefulness of preventive low-molecular-weight heparin (LMWH) after cesarean delivery remains a matter of controversy. It was the objective of this study to evaluate the usefulness of thromboprophylaxis with LMWH after cesarean delivery. A decision model was constructed to evaluate the risks and benefits associated with a seven-day LMWH prophylaxis, compared with none. All probabilities were obtained from literature according to the highest level of evidence. We performed our analysis on two different sets of outcomes (utilities and disutilities), to calculate the quality-adjusted life expectancy at three months. Finally, we calculated the outcomes for four hypothetical cases with different risk. Prophylaxis with LMWH yielded the highest quality-adjusted life expectancy, with a net gain of 1.5–2.8 quality-adjusted days. Sensitivity analyses showed the incidence of VTE after cesarean delivery and the haemorrhagic risk related to LMWH to be critical, at threshold values of 0.15–0.22% and 0.23–0.35%, respectively. In the hypothetical cases, LMWH was safe but only marginally more effective in women with no risk factors. In case of an emergency procedure, a body-mass index >25kg/m2, tobacco smoking, or any combination of these, reductions in VTE greatly outnumbered the increase in major haemorrhages, with a modest benefit on mortality. Our decision analysis suggests that the benefits of LMWH after cesarean delivery exceed the risks. This benefit is, however, very low in women with no risk factors.

Cost-effectiveness of low-molecular-weight heparin for secondary prophylaxis of cancer-related venous thromboembolism

2005 ◽  
Vol 93 (03) ◽  
pp. 592-599 ◽  
Author(s):  
Kenneth Smith ◽  
Jacques Cornuz ◽  
Mark Roberts ◽  
Drahomir Aujesky
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Cost Effectiveness ◽  
Life Expectancy ◽  
Low Molecular Weight Heparin ◽  
Secondary Prophylaxis ◽  
Low Molecular Weight ◽  
Old Patients ◽  
Life Years ◽  
Quality Adjusted Life

SummaryAlthough extended secondary prophylaxis with low-molecular-weight heparin was recently shown to be more effective than warfarin for cancer-related venous thromboembolism, its cost-effectiveness compared to traditional prophylaxis with warfarin is uncertain. We built a decision analytic model to evaluate the clinical and economic outcomes of a 6-month course of low-molecular-weight heparin or warfarin therapy in 65-year-old patients with cancer-related venous thromboembolism. We used probability estimates and utilities reported in the literature and published cost data. Using a US societal perspective, we compared strategies based on quality-adjusted life-years (QALYs) and lifetime costs. The incremental cost-effectiveness ratio of low-molecular-weight heparin compared with warfarin was $149, 865/QALY. Low-molecular-weight heparin yielded a quality-adjusted life expectancy of 1.097 QALYs at the cost of $15, 329. Overall, 46% ($7108) of the total costs associated with low-molecular-weight heparin were attributable to pharmacy costs. Although the low-molecular-weigh heparin strategy achieved a higher incremental quality-adjusted life expectancy than the warfarin strategy (difference of 0.051 QALYs), this clinical benefit was offset by a substantial cost increment of $7,609. Cost-effectiveness results were sensitive to variation of the early mortality risks associated with low-molecular-weight heparin and warfarin and the pharmacy costs for low-molecular-weight heparin. Based on the best available evidence, secondary prophylaxis with low-molecular-weight heparin is more effective than warfarin for cancer-related venous thromboembolism. However, because of the substantial pharmacy costs of extended low-molecular-weight heparin prophylaxis in the US, this treatment is relatively expensive compared with warfarin.

scholarly journals Cerebral Venous Thrombosis after a Cesarean Delivery

2010 ◽  
Vol 53 (2) ◽  
pp. 109-113 ◽  
Author(s):  
Edvard Ehler ◽  
Aleš Kopal ◽  
Milan Mrklovský ◽  
Milan Košťál
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thrombosis ◽  
Cesarean Delivery ◽  
Cerebral Venous Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Methylenetetrahydrofolate Reductase ◽  
Low Molecular Weight ◽  
Viii Level ◽  
Risk Patients

Cerebral venous thrombosis (CVT) is a serious condition affecting mostly women. This report concerns two cases of women who developed CVT within 14 days of cesarean delivery. Magnetic resonance angiography of the brain (venous phase) is the best modality to diagnose the condition, and parenteral application of low-molecular-weight heparin is the most beneficial treatment. The first patient was found to have an elevated factor VIII level. In the second patient, homozygosity of the C677T mutation in the 5,10-methylenetetrahydrofolate reductase gene was found. The puerperal period and Cesarean Section (CS) are risk factors for thrombotic complications, including CVT. It is necessary to search for risk factors in a patient’s history and within the group of at-risk patients to prolong preventive administration of low molecular weight heparin (LMWH). CVT (including puerperium related) is not a detrimental to future pregnancies.

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>

scholarly journals Risk factors and role of low molecular weight heparin in obstetric complications among women with inherited thrombophilia – a cohort study

2019 ◽  
Vol 41 (4) ◽  
pp. 303-309
Author(s):  
María Manuela Clavijo ◽  
Carolina Valeria Mahuad ◽  
María de los Angeles Vicente Reparaz ◽  
María Florencia Aizpurua ◽  
Adriana Ventura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Cohort Study ◽  
Low Molecular Weight Heparin ◽  
Obstetric Complications ◽  
Low Molecular Weight ◽  
Inherited Thrombophilia

scholarly journals Is Low Molecular Weight Heparin the Treatment of choice for Neonatal Thrombosis?

2020 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Caesarean Section ◽  
Low Molecular Weight Heparin ◽  
Inferior Vena ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Emergency Caesarean Section ◽  
Low Molecular Weight ◽  
Preterm Baby

A borderline preterm baby is born with an emergency caesarean section. The baby is found to have an unprovoked occlusive thrombosis in the left renal vein and inferior vena cava. There are no obvious risk factors for thrombosis. The baby is commenced on un-fractionated heparin (UFH) followed by a prolonged course of low molecular weight heparin (LMWH) based on the guidelines adopted from adult evidence. You wonder if this is reasonable to treat neonates as per adult guidelines given the great differences between adult and neonatal clotting parameters.

scholarly journals Thromboembolism and antithrombotic management in pregnancy

2011 ◽  
Vol 152 (21) ◽  
pp. 815-821 ◽  
Author(s):  
Attila Pajor
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Individual Risk ◽  
Low Molecular Weight ◽  
Pregnancy And Delivery ◽  
Individual Risk Factors ◽  
In Pregnancy

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.

The Effect of Low Molecular Weight Heparin on Survival in Patients With Advanced Malignancy

2005 ◽  
Vol 23 (10) ◽  
pp. 2130-2135 ◽  
Author(s):  
Clara P.W. Klerk ◽  
Susanne M. Smorenburg ◽  
Hans-Martin Otten ◽  
Anthonie W.A. Lensing ◽  
Martin H. Prins ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Life Expectancy ◽  
Median Survival ◽  
Major Bleeding ◽  
Low Molecular Weight Heparin ◽  
Hazard Ratio ◽  
Low Molecular Weight ◽  
Double Blind Study ◽  
Advanced Malignancy

Purpose Studies in cancer patients with venous thromboembolism suggested that low molecular weight heparin may prolong survival. In a double-blind study, we evaluated the effect of low molecular weight heparin on survival in patients with advanced malignancy without venous thromboembolism. Methods Patients with metastasized or locally advanced solid tumors were randomly assigned to receive a 6-week course of subcutaneous nadroparin or placebo. The primary efficacy analysis was based on time from random assignment to death. The primary safety outcome was major bleeding. Results In total, 148 patients were allocated to nadroparin and 154 patients were allocated to placebo. Mean follow-up was 1 year. In the intention-to-treat analysis the overall hazard ratio of mortality was 0.75 (95% CI, 0.59 to 0.96) with a median survival of 8.0 months in the nadroparin recipients versus 6.6 months in the placebo group. After adjustment for potential confounders, the treatment effect remained statistically significant. Major bleeding occurred in five (3%) of nadroparin-treated patients and in one (1%) of the placebo recipients (P = .12). In the a priori specified subgroup of patients with a life expectancy of 6 months or more at enrollment, the hazard ratio was 0.64 (95% CI, 0.45 to 0.90) with a median survival of 15.4 and 9.4 months, respectively. For patients with a shorter life expectancy, the hazard ratio was 0.88 (95% CI, 0.62 to 1.25). Conclusion A brief course of subcutaneous low molecular weight heparin favorably influences the survival in patients with advanced malignancy and deserves additional clinical evaluation.

scholarly journals Intermediate Dose Low-Molecular-Weight Heparin for Thrombosis Prophylaxis: Systematic Review with Meta-Analysis and Trial Sequential Analysis

2019 ◽  
Vol 45 (08) ◽  
pp. 810-824 ◽  
Author(s):  
Ruben J. Eck ◽  
Wouter Bult ◽  
Jørn Wetterslev ◽  
Reinold O.B. Gans ◽  
Karina Meijer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Molecular Weight ◽  
Major Bleeding ◽  
Low Molecular Weight Heparin ◽  
Risk Of Bias ◽  
Sensitivity Analyses ◽  
Thrombosis Prophylaxis ◽  
Low Molecular Weight ◽  
All Cause Mortality ◽  
Intermediate Dose

AbstractDifferent doses of low-molecular-weight heparin (LMWH) are registered and used for thrombosis prophylaxis. We assessed benefits and harms of thrombosis prophylaxis with a predefined intermediate-dose LMWH compared with placebo or no treatment in patients at risk of venous thromboembolism (VTE). We performed a systematic review with meta-analyses and trial sequential analyses (TSA) following The Cochrane Handbook for Systematic Reviews of Interventions. Medline, Cochrane CENTRAL, Web of Science, and Embase were searched up to December 2018. Trials were evaluated for risk of bias and quality of evidence was assessed following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Seventy randomized trials with 34,046 patients were included. Eighteen (26%) had overall low risk of bias. There was a small statistically significant effect of LMWH on all-cause mortality (risk ratio [RR]: 0.96; TSA-adjusted confidence interval [TSA-adjusted CI]: 0.94–0.98) which disappeared in sensitivity analyses excluding ambulatory cancer patients (RR: 0.99; TSA-adjusted CI: 0.84–1.16). There was moderate-quality evidence for a statistically significant beneficial effect on symptomatic VTE (odds ratio [OR]: 0.59; TSA-adjusted CI: 0.53–0.67; number needed to treat [NNT]: 76; 95% CI: 60–106) and a statistically significant harmful effect on major bleeding (Peto OR: 1.66; TSA-adjusted CI: 1.31–2.10; number needed to harm [NNH]: 212; 95% CI: 142–393). There were no significant intervention effects on serious adverse events. The use of intermediate-dose LMWH for thrombosis prophylaxis compared with placebo or no treatment was associated with a small statistically significant reduction of all-cause mortality that disappeared in sensitivity analyses excluding trials that evaluated LMWH for anticancer treatment. Intermediate-dose LMWH provides benefits in terms of VTE prevention while it increases major bleeding.

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