Management of heparin allergy during pregnancy with danaparoid.
We report a patient who presented with a left proximal deep vein thrombosis at 25 + 5 weeks gestation. She developed a severe urticarial rash 3 weeks following initiation of therapy with Enoxaparin. The patient was heterozygous for the factor V Leiden mutation. She was treated with subcutaneous twice-daily danaparoid (Orgaran) for the remainder of the pregnancy, achieving anti-Xa levels in the therapeutic range 0.5-1.0 IU/ml. Delivery was at term by caesarean section 2 days after spontaneous rupture of membranes and failure to progress in labour. Danaparoid was withheld during this time. Danaparoid was restarted 3 h post delivery and the patient anticoagulated with warfarin in the post-partum period. There was no recurrence of thrombosis or bleeding events during therapy with danaparoid. No anti-Xa activity was demonstrated in breast milk.
Harrison
S J
SJ
Department of Haematology, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
Rafferty
I
I
McColl
M D
MD
D000328:Adult; D002585:Cesarean Section; D002809:Chondroitin Sulfates / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use*; D003871:Dermatan Sulfate / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use*; D004338:Drug Combinations; D004342:Drug Hypersensitivity; D017984:Enoxaparin / Q000009:adverse effects* / Q000627:therapeutic use; D005165:Factor V / Q000235:genetics; D065427:Factor Xa Inhibitors; D005260:Female; D005865:Gestational Age; D006497:Heparan Sulfate / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use*; D006579:Heterozygote; D006801:Humans; D007279:Injections, Subcutaneous; D008895:Milk, Human / Q000737:chemistry; D009154:Mutation; D011247:Pregnancy; D020246:Venous Thrombosis / Q000188:drug therapy*
D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D017984:Enoxaparin; D005165:Factor V; D065427:Factor Xa Inhibitors; D006497:Heparan Sulfate; C095381:factor V Leiden; C035838:danaparoid