Low molecular weight heparin for the treatment of venous thromboembolism in pregnancy: a case series.
OBJECTIVE
To assess the use of low molecular weight heparin for the treatment of venous thromboembolism in pregnancy.


METHODS
A prospective observational study.


METHODS
The maternity units in two university teaching hospitals and one district general teaching hospital.


METHODS
Thirty-six consecutive women presenting with objectively diagnosed venous thromboembolism during pregnancy and the immediate puerperium.


METHODS
Treatment with the low molecular weight heparin enoxaparin, approximately 1 mg/kg s.c., twice daily, based on early pregnancy weight.


METHODS
Peak anti-Xa activity (three hours post-injection), alterations in treatment, side effects and the use of regional anaesthesia.


RESULTS
In 33 women, the initial dose of enoxaparin provided satisfactory peak anti-Xa activity (median 0.8 u/mL, range 0.44-1.0 u/mL) and was continued. Three women required dose reduction since peak anti-Xa activities were above the therapeutic range (1.2, 1.2 and 1.1 u/mL). No woman developed thrombocytopaenia, haemorrhagic complication or further thromboembolic episode. Two women developed allergic skin reactions on enoxaparin and were changed to tinzaparin. Fifteen women had regional anaesthesia for delivery, with a reduced dose of enoxaparin (40 mg once daily), all without complication.


CONCLUSIONS
Enoxaparin is a safe and effective treatment for venous thromboembolism during pregnancy and confers a major advantage over unfractionated heparin through its simplified regimen of administration.
Rodie
V A
VA
Department of Obstetrics and Gynaecology, University of Glasgow, Glasgow Royal Infirmary, UK.
Thomson
A J
AJ
Stewart
F M
FM
Quinn
A J
AJ
Walker
I D
ID
Greer
I A
IA
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D000990:Antithrombin III / Q000378:metabolism; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy*; D011446:Prospective Studies; D013923:Thromboembolism / Q000188:drug therapy*; D020246:Venous Thrombosis / Q000188:drug therapy*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D000990:Antithrombin III