Low-molecular-weight heparin in pregnancy: peripartum bleeding complications.
OBJECTIVE
To compare bleeding complications in pregnant patients treated with low-molecular-weight heparin (LMWH) to untreated controls.


METHODS
A case-control study of patients from 2001 to 2005 who received prophylactic or therapeutic doses of LMWH during pregnancy was carried out. Indications for LMWH included current or prior thromboembolism, thrombophilia, or heart valve replacement. Controls were chosen in a 2:1 ratio to cases, matched for delivery route, and selected as the next two consecutive deliveries. The primary outcome was postpartum hemorrhage (PPH). Odds ratios (ORs) were calculated with 95% confidence intervals (CIs).


RESULTS
Forty-nine women treated with LMWH delivered 55 infants. Current or prior thromboembolic disease was the anticoagulation indication in 15/55 (27.3%) and 26/55 (47%) of pregnancies, respectively. There were more obese gravidas (OR 3.91, CI 1.70 to 9.09) and labor induction was more common in the LMWH group, 25/55 (45%) vs 29/110 (26%), P=0.01. There was no difference in estimated blood loss (295.7+/-145.7 vs 308.6+/-111.9 cm(3), P=0.62 vaginal; 687.5+/-251.8 vs 765.0+/-313.2 cm(3), P=0.34 cesarean), PPH (6/55, 11% vs 9/110, 8.2% OR 1.37, CI 0.16 to 11.5) or transfusion (3/55, 5.4% vs 4/110, 3.6% OR 1.50, CI 0.3 to 7.48) between the cases and controls. There were two cases of postpartum pulmonary emboli, one with a maternal mortality.


CONCLUSIONS
Bleeding complications, including PPH and transfusion, in patients treated with LMWH during pregnancy were not increased when compared to normal controls matched for delivery route.
Kominiarek
M A
MA
Department of Obstetrics and Gynecology, College of Medicine, University of Illinois Medical Center at Chicago, IL 60607, USA. mkomin1@uic.edu
Angelopoulos
S M
SM
Shapiro
N L
NL
Studee
L
L
Nutescu
E A
EA
Hibbard
J U
JU
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007231:Infant, Newborn; D006473:Postpartum Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000517:prevention & control*; D011256:Pregnancy Outcome; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight