[Danaparoid in pregnancy in cases of heparin intolerance - use in 59 cases].
During the use of fractionated or unfractionated heparin adverse events frequently occur that can endanger the continuation of therapy. Especially in pregnant patients with thromboembolic complications it may be difficult to find a suitable alternative anticoagulant when heparin-induced thrombocytopenia type II (HIT II) or allergic skin reactions occur. There are still limited data on the use of danaparoid in pregnancy. The main reason for heparin intolerance in the 59 reviewed pregnancies were either HIT II, described in 37/59 (62.7%) pregnancies, or cutaneous adverse effects in 19/22 (86.4%) of non-HIT-associated pregnancies (22/59, 37.3%).


RESULTS
40/59 pregnancies were carried to term under use of danaparoid and resulted in the delivery of a healthy infant. In 16/19 pregnancies, danaparoid was stopped due to a major adverse event. Five patients showed bleeding complications, seven fetal losses were documented, but there was no association with the use of danaparoid. In 31/59 (52.5%) pregnancies adverse events were documented, 14/31 (45.2%) could be attributed to danaparoid. Anti-Xa-activity was not detected in five fetal cord blood samples and in four maternal breast-milk samples.


CONCLUSIONS
Danaparoid can be used as an alternative anticoagulant in pregnant women with high risk for thrombosis and heparin intolerance.
Schindewolf
M
M
Gefässzentrum, Schwerpunkt Angiologie/Hämostaseologie, Medizinische Klinik III, Johann-Wolfgang-Goethe Universität, Theodor-Stern-Kai 7, 60590 Frankfurt am Main. marc.schindewolf@kgu.de
Magnani
H N
HN
Lindhoff-Last
E
E
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D003871:Dermatan Sulfate / Q000627:therapeutic use*; D065427:Factor Xa Inhibitors; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006497:Heparan Sulfate / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy; D011256:Pregnancy Outcome; D013921:Thrombocytopenia / Q000139:chemically induced; D013927:Thrombosis / Q000188:drug therapy
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D065427:Factor Xa Inhibitors; D006493:Heparin; D006497:Heparan Sulfate; C035838:danaparoid