title: Postpartum bone mineral density in women treated for thromboprophylaxis with unfractionated heparin or LMW heparin.
abstract: Venous thromboembolism remains an important cause of maternal mortality. In a randomised open study, 44 pregnant women with confirmed previous or current thromboembolism were randomised to receive either low-molecular-weight heparin, dalteparin (N = 21) once daily subcutaneously or unfractionated sodium heparin (UF heparin, N = 23) twice daily subcutaneously for thromboprophylaxis during pregnancy and puerperium. Bone mineral density (BMD) in the lumbosacral spine was measured with dual X-ray absorptiometry (DEXA) 1, 6, 16, 52 weeks and, if possible, 3 years after delivery. BMD values were also compared with those of healthy, delivered women (N = 19). Mean BMD of the lumbar spine was significantly lower in the unfractionated heparin group compared with the dalteparin and with the control groups (repeated measures ANOVA p = 0.02). BMD in the dalteparin group did not differ from BMD of healthy delivered women. Multiple logistic regression analysis revealed that therapy was the only independent factor influencing BMD at weeks 16 and 52. Therefore we recommend use of dalteparin instead of UF heparin for long-term thromboprophylaxis during and after pregnancy.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Finland.
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.forename: Pekka
authors.initials: P
authors.lastname: Leinonen
authors.forename: Antti
authors.initials: A
authors.lastname: Markkola
authors.forename: Vilho
authors.initials: V
authors.lastname: Hiilesmaa
authors.forename: Risto
authors.initials: R
authors.lastname: Kaaja
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects*; D017985:Dalteparin / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D065427:Factor Xa Inhibitors; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology; D006493:Heparin / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008159:Lumbar Vertebrae / Q000737:chemistry* / Q000000981:diagnostic imaging / Q000187:drug effects; D010024:Osteoporosis / Q000139:chemically induced* / Q000150:complications; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control*; D011644:Puerperal Disorders / Q000139:chemically induced*; D012307:Risk Factors; D013122:Spinal Diseases / Q000453:epidemiology; D016103:Spinal Fractures / Q000209:etiology; D013923:Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D006493:Heparin; D017985:Dalteparin