Recurrence and severity of abnormal pregnancy outcome in patients treated by low-molecular-weight heparin: a prospective pilot study

Background: The objective of this study was to determine the outcomes of Low Molecular Weight Heparin Therapy (LMWH) given for various indications during pregnancy.Methods: In this context, a detailed retrospective analysis of all the patients who received LMWH for various indications over a period of two years from October 2015 to November 2017 at a single center, Sri Aurobindo Medical College and PG institute in Indore was performed.Results: Total 100 patients were studied, included over the period of 2 years for various indications for which Enoxaparin (1 mg/kg body weight OD/BD subcutaneously) was used. The indications were valvular heart disease with valve replacement and atrial fibrillation (54.0%), chronic deep vein thrombosis (DVT) (13.0%), thrombophilias (9.0%), recurrent pregnancy loses (21.0%) and prophylaxis for deep vein thrombosis (3.0%) in overall patients. Abortion was seen in 8.0 % patients; fetal growth restriction in 13% patients; and oligohydramnios, preeclampsia, gestational hypertension, placenta previa, abruptio placentae, postpartum hemorrhage patients and Stillbirth occurred in 4.0 % patients. No thromboembolic event was noted in any of the patients. None of the patients had any documented thrombocytopenia or clinical fracture.Conclusions: Low Molecular Weight Heparin Therapy (LMWH) used amongst pregnant women with various indications for anticoagulation therapy was associated with successful pregnancy outcome in the vast majority of cases. Further multicenter prospective studies and international registries of pregnant women on LMWH are necessary to broaden our knowledge in optimizing the care of women who require anticoagulation during pregnancy.

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Preeclampsia and pregnancy loss in women with a history of venous thromboembolism and prophylactic low-molecular-weight heparin (LMWH) during pregnancy

Thrombosis and Haemostasis ◽

10.1160/th06-03-0165 ◽

2006 ◽

Vol 96 (09) ◽

pp. 285-289 ◽

Cited By ~ 6

Author(s):

Guelay Alguel ◽

Rainer Vormittag ◽

Ralph Simanek ◽

Paul Kyrle ◽

Peter Quehenberger ◽

...

Keyword(s):

Molecular Weight ◽

Pregnancy Outcome ◽

Low Molecular Weight Heparin ◽

Post Partum ◽

Control Group ◽

Low Molecular Weight ◽

Limited Data ◽

Vein Thrombosis ◽

History Of ◽

Risk Of Preeclampsia

SummaryLimited data are available regarding complications of pregnancy and pregnancy outcome under prophylaxis with low-molecular-weight heparin (LMWH) in women with a history of thromboembolism (TE).We retrospectively evaluated pregnancy complications ina cohort of 80 women. All hada history of TE (76 venous, two arterial and two venous and arterial) and received prophylactic LMWH during 86 pregnancies. The rate of preeclampsia and stillbirth in these women was compared to that of a control group of 313 women without a history of TE and LMWH. Prophylaxis was started at a median of 10 weeks of gestation and usually continued until six weeks post partum. In 94% of the cases the outcome of pregnancy was favourable with a live birth. Four pregnancies (4.7%) ended in miscarriage. Two (2.3%) pregnancies were complicated bya thromboembolic event (one deep leg vein thrombosis and PRIND, respectively). One patient developed HELLP-syndrome. Severe preeclampsia occurred in three (3.8%) and stillbirth in one (1.3%) of the patients (n=80), whereas this was the case in four (1.3%, odds ratio 3.01; 95% confidence interval (CI) 0.66–13.73, p=0.15) and 10 (3.2%, OR=0.38; 95% CI 0.05–3.04, p=0.72) control women. Mean birth weight and standard deviation of infants was 3,160± 930 g in patients and 3,300 ± 540 g in controls (p=0.11).We conclude that a favourable pregnancy outcome in women with a history of thromboembolism who use prophylactic LMWH during pregnancy can be expected. There was a trend towardsa higher risk of preeclampsia, and these women should be carefully monitored for this complication.

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