Low-molecular-weight heparin-induced skin necrosis without platelet fall: a case report in pregnancy

2017 ◽  
Vol 6 (1) ◽  
Author(s):  
Emine Aydin ◽  
Esra Nuhoglu ◽  
Gökçen Orgul ◽  
Sema Can ◽  
Ozgür Deren
Keyword(s):  
Molecular Weight ◽  
Skin Necrosis ◽  
Low Molecular Weight Heparin ◽  
Factor V Leiden ◽  
Skin Lesions ◽  
Low Molecular Weight ◽  
Factor V ◽  
Prophylactic Regimen ◽  
Factor V Leiden Mutation ◽  
Dermal Cells

Abstract Background: Skin necrosis, following subcutaneously administered low-molecular-weight heparin (LMWH) is a rare but serious complication and has not been documented during pregnancy in the literature to the best of our knowledge. Therefore, we are of the opinion that reporting this case may guide clinicians when presented with such patients. Main observations: A 36-year-old woman with painful skin lesions was admitted to our clinic at 36 gestational weeks’ of her first pregnancy. There was nothing remarkable in her medical history other than using prophylactic regimen of “low-molecular-weight heparin” (enoxaparine) 4000 units anti-Xa subcutaneously because of heterozygous factor V Leiden mutation. Potential reasons of the lesions were considered to be immunological reaction between heparin and dermal cells and management considered with these findings. Conclusions: Heparin-induced skin necrosis (HISN) is a condition that should always be borne in mind when there are nonspecific results. Enoxaparine treatment during pregnancy has a rare potential risk of causing necrosis at the injection site and it is reversible with careful intervention.

scholarly journals Successful Conservative Treatment of a Complicated Aortic Thrombus in a Woman with Factor V Leiden Mutation

2021 ◽  
Author(s):  
Elise Frebutte ◽  
Myriam Bibombe ◽  
Arthur Dumont ◽  
Maxime Haxhe ◽  
Pascal Reper
Keyword(s):  
Molecular Weight ◽  
Conservative Treatment ◽  
Low Molecular Weight Heparin ◽  
Rare Complication ◽  
Factor V Leiden ◽  
Low Molecular Weight ◽  
Factor V ◽  
Factor V Leiden Mutation ◽  
Therapeutic Anticoagulation ◽  
Aortic Thrombus

Thrombus in the aortic trunk is a rare complication. We report the case of a 63-year-old patient with a factor V Leiden mutation in whom an aortic arch thrombus was discovered accidentally. Conservative treatment was initiated with therapeutic anticoagulation with low-molecular-weight heparin leading to complete thrombus lysis after 3 months but associated shortly after anticoagulation initiation with a large splenic and limited renal infarctions.

Thrombogenesis in Thrombophilic Pregnancy: Evaluation of Low-Molecular-Weight Heparin Prophylaxis

2017 ◽  
Vol 137 (4) ◽  
pp. 201-206 ◽  
Author(s):  
Roberto Simeone ◽  
Roberta Giacomello ◽  
Germano Bruno ◽  
Sergio Parco ◽  
Natalia Maximova ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Pregnant Women ◽  
Low Molecular Weight Heparin ◽  
Factor V Leiden ◽  
Control Group ◽  
Low Molecular Weight ◽  
Factor V ◽  
Protein C Deficiency ◽  
Factor V Leiden Mutation ◽  
Heparin Prophylaxis

The aim of this study is to investigate thrombogenesis and the hypercoagulable changes in pregnant women affected by thrombophilia who received low-molecular-weight heparin (LWMH) prophylaxis. We included 21 pregnant women affected by thrombophilia treated with LWMH and 20 nontreated normal pregnant women as the control group. The sample group of thrombophilic pregnant women included different conditions (factor V Leiden mutation, protein C deficiency, protein S deficiency, antiphospholipid antibodies syndrome, and combined defects). Three blood samples were collected during pregnancy (i.e., at 16, 20, and 24 weeks) and tested for activated partial thromboplastin time and prothrombin fragment F1 + 2 (F1 + 2); anti-FXa activity was tested only in treated thrombophilic pregnant women. F1 + 2 levels progressively increased during pregnancy in both study groups. However, the F1 + 2 increase in women exposed to heparin prophylaxis was significantly lower than that in normal pregnant women in all 3 measurements carried out during gestation (p < 0.05); a statistically significant inverse correlation between F1 + 2 levels and anti-Xa activity (R = -0.8575, p < 0.05) was observed in treated women during pregnancy. Our findings suggest that F1 + 2 in addition to anti-Xa measurement could be used to adjust LWMH prophylaxis, at least in high-risk pregnant women.

Obstetric complications and pregnancy-related venous thromboembolism: The effect of low-molecular-weight heparin on their prevention in carriers of factor V Leiden or prothrombin G20210A mutation

2012 ◽  
Vol 107 (03) ◽  
pp. 477-484 ◽  
Author(s):  
Elvira Grandone ◽  
Valerio De Stefano ◽  
Alberto Tosetto ◽  
Gualtiero Palareti ◽  
Maurizio Margaglione ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Factor V Leiden ◽  
Obstetric Complications ◽  
Prothrombin G20210a ◽  
Low Molecular Weight ◽  
Factor V ◽  
G20210a Mutation ◽  
Before And After

SummaryWhether the administration of low-molecular-weight heparin (LMWH) during pregnancy is effective in preventing obstetric complications and pregnancy-related venous thromboembolism (VTE) in women who are carriers of factor V Leiden (FVL) and/or prothrombin variant G20210A (PTm) is controversial. This observational study investigated the possible efficacy of pharmacological treatment with LMWH ± aspirin (ASA) in pregnancy outcomes in 1,011 pregnancies of 416 women with thrombophilia (FVL and/or PTm). Most patients were chosen on the basis of previous obstetrical complications (36%), or because of familial or personal history of venous/arterial thromboembolism (28% and 18%, respectively); 74 patients (18%) were incidentally identified. The outcome was evaluated according to the type of treatment and of the period of pregnancy when the treatment was started. After adjustment for observation before and after diagnosis of thrombophilia, previous miscarriages and VTE, parity, age and centre, we observed that LMWH had a protective effect on miscarriages (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.29–0.94) and VTE (OR 0.05, 95% CI 0.01–0.21). ASA appeared to have no effect on the prevention of obstetric complications and VTE. A nested analysis performed in 116 women with two or more obstetric complications confirmed that the highest number of live births was recorded in the group under LMWH prophylaxis (OR 0.19, 95% CI 0.05–0.75). These results suggest that LMWH prophylaxis reduces the risk of obstetric complications in carriers of FVL and/or PTm, particularly in those with previous obstetric events. Furthermore, LMWH prophylaxis reduces the risk of pregnancy-related VTE.

Low-molecular-weight heparin versus low-dose aspirin in women with one fetal loss and a constitutional thrombophilic disorder

Blood ◽  
2004 ◽  
Vol 103 (10) ◽  
pp. 3695-3699 ◽  
Author(s):  
Jean-Christophe Gris ◽  
Eric Mercier ◽  
Isabelle Quéré ◽  
Géraldine Lavigne-Lissalde ◽  
Eva Cochery-Nouvellon ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Fetal Loss ◽  
Factor V Leiden ◽  
Low Molecular Weight ◽  
Protein Z ◽  
Factor V Leiden Mutation ◽  
Dose Aspirin ◽  
Low Dose Aspirin

Abstract The prospective evaluation of the effect of thromboprophylaxis in women with one unexplained pregnancy loss from the 10th week of amenorrhea was performed. A total of 160 patients with heterozygous factor V Leiden mutation, prothrombin G20210A mutation, or protein S deficiency were given 5 mg folic acid daily before conception, to be continued during pregnancy, and low-dose aspirin 100 mg daily or low-molecular-weight heparin enoxaparin 40 mg was taken from the 8th week. Twenty-three of the 80 patients treated with low-dose aspirin and 69 of the 80 patients treated with enoxaparin had a healthy live birth (odds ratio [OR], 15.5; 95% confidence interval [CI], 7-34, P &lt; .0001). Enoxaparin was superior to low-dose aspirin in each subgroup defined according to the underlying constitutional thrombophilic disorder. An associated protein Z deficiency and/or positive antiprotein Z antibodies were associated with poorer outcomes. The neonate weight was higher in the women successfully treated with enoxaparin, and neonates small for gestational age were more frequent in patients treated with low-dose aspirin. No significant side effects of the treatments could be evidenced in patients or newborns. As there is no argument to prove that low-dose aspirin may have been deleterious, these results support enoxaparin use during such at-risk pregnancies.

scholarly journals Pregnancy-associated venous thromboembolism in combined heterozygous factor V Leiden and prothrombin G20210A mutations

2005 ◽  
Vol 123 (6) ◽  
pp. 286-288 ◽  
Author(s):  
Egle Couto ◽  
Marcelo Luís Nomura ◽  
Ricardo Barini ◽  
João Luiz Pinto e Silva
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Factor V Leiden ◽  
Low Molecular Weight ◽  
Factor V ◽  
Thromboembolic Events ◽  
The Real

CONTEXT: Pregnancy and puerperium raise the risk of thromboembolic events, and these risks are increased in women who are carriers of thrombophilia factors. Prothrombin (FII) G20210A and factor V Leiden heterozygous mutations are associated with moderate risk of thrombosis. The association of these thrombophilic conditions is very rare in pregnancy, and the real risk of thrombosis is unknown. CASE REPORT: We describe a case of a pregnant woman who was found to be carrier of heterozygous factor V Leiden and prothrombin (FII) G20210A mutations. Five years before pregnancy she had had an episode of extensive deep venous thrombosis in the ileofemoral region, while using hormonal contraceptives. Anticardiolipin antibody (ACA), lupus anticoagulant and deficiencies of protein C, protein S and antithrombin III were evaluated by means of enzyme-linked immunosorbent assay (ELISA), dilute Russell Viper Venom time (dRVVT), coagulometric and chromogenic methods. Deoxyribonucleic acid (DNA) was amplified using the polymerase chain reaction (PCR) to study the factor V Leiden and G20210A mutations in the prothrombin gene and C677T mutation in the methylene tetrahydrofolate reductase (MTHFR) gene. In the sixth week of her first pregnancy, she developed another episode of deep venous thrombosis in the femoropopliteal veins of the right leg. She was treated with low-molecular weight heparin (nadroparin) until parturition (0.3 ml or 2,850 UI/day). The pregnancy evolved without any significant obstetric morbidity. The patient delivered a healthy baby by cesarean section. During the puerperium, she used prophylactic doses of nadroparin for (0.3 ml or 2,850 UI/day) six weeks and had no complications. We suggest that women who have an association of thrombophilia factors and a prior episode of venous thromboembolism must have antepartum anticoagulation management using unfractioned or low-molecular weight heparin and postpartum management using low-molecular weight heparin or oral anticoagulants. Anticoagulation is recommended during pregnancy because the real magnitude of the risk of major and life-threatening thromboembolic events in these women is unknown.

scholarly journals Duration of thromboprophylaxis with low-molecular-weight heparin after abdominal delivery in Factor V Leiden carriers

2021 ◽  
pp. 73-78
Author(s):  
Mariya M. Sirazitdinova ◽  
Natalia M. Pasman ◽  
Yulia N. Vagner ◽  
Andrey P. Momot ◽  
Mariya G. Nikolaeva
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Factor V Leiden ◽  
Low Molecular Weight ◽  
Factor V ◽  
Abdominal Delivery
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