title: Prophylactic use of danaparoid in high-risk pregnancy with heparin-induced thrombocytopaenia-positive skin reaction.
abstract: We describe a case where danaparoid was used prophylactically in a high-risk twin pregnancy following the development of heparin-allergy while on prophylactic dalteparin. Danaparoid was substituted for dalteparin at 20 weeks of pregnancy following the development of a severe skin reaction while on the low molecular weight heparin. Although there was no significant fall in platelet count, an aggregation assay for heparin-induced thrombocytopaenia was positive. The skin lesions rapidly resolved following the change to subcutaneous danaparoid. Delivery was by emergency caesarian section at 35 weeks under a general anaesthetic, as a dose of danaparoid had been given 6 h prior to delivery. A sample of breast milk showed no anti-activated factor X activity. Danaparoid was continued post-delivery until the patient was fully warfarinized. To our knowledge, there are no previous reports of the use of danaparoid in this setting.
authors.affiliation: Department of Clinical Haematology, Queen's Medical Centre, University Hospital, Nottingham, UK. bmyers@hospital-doctor.net
authors.forename: Bethan
authors.initials: B
authors.lastname: Myers
authors.forename: John
authors.initials: J
authors.lastname: Westby
authors.forename: Jane
authors.initials: J
authors.lastname: Strong
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D002585:Cesarean Section; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D003871:Dermatan Sulfate / Q000627:therapeutic use*; D004338:Drug Combinations; D003875:Drug Eruptions / Q000209:etiology; D004630:Emergencies; D005260:Female; D006493:Heparin / Q000009:adverse effects; D006497:Heparan Sulfate / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007279:Injections, Subcutaneous; D010976:Platelet Count; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control*; D018566:Pregnancy, High-Risk; D011272:Pregnancy, Multiple; D011644:Puerperal Disorders / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000517:prevention & control; D013921:Thrombocytopenia / Q000209:etiology; D013927:Thrombosis / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D006493:Heparin; D006497:Heparan Sulfate; D014859:Warfarin; C035838:danaparoid