Venous thromboembolism in pregnancy: prophylaxis and treatment with low molecular weight heparin.
OBJECTIVE
To evaluate the safety of individually dosed low molecular weight heparin (LMWH) for prophylaxis and treatment of thromboembolic complications in pregnancy.


METHODS
Cohort study with a chronologic register-based control group.


METHODS
Department of Obstetrics and Gynecology, Hillerød Hospital, Denmark.


METHODS
All 166 women treated with LMWH in pregnancy between 1 January 2001 and 31 December 2005.


METHODS
Women treated with LMWH in pregnancy were identified and individual case records reviewed retrospectively. General data on the LMWH-treated women were compared to the 18,020 untreated pregnancies within the same period and with 306 matched controls as regards to postpartum hemorrhage (PPH).


METHODS
Side effects of treatment, thromboembolic manifestations, postpartum bleeding and obstetric outcome.


RESULTS
There were no thromboembolic events during therapy, few side effects of treatment and no osteoporotic fractures or episodes of heparin-induced thrombocytopenia. The 166 pregnancies resulted in 159 live infants. There was a significantly higher risk of preterm delivery (13% vs. 6%) and intrauterine growth restriction (4.4% vs. 3.5%). Delivery by cesarean section was more common in these high-risk LMWH-treated pregnancies (33.1%) than in untreated pregnancies (19.2%). In the LMWH-group, the occurrence of PPH was 7.2% compared with 8.8% in the matched untreated control group (p = 0.675). None of the events in the LMWH group were serious and all 166 women were in good health at discharge.


CONCLUSIONS
Individually dosed LMWH is well tolerated and safe for prophylaxis and treatment of thromboembolic complications during pregnancy, delivery and the postpartum period.
Andersen
Anita Sylvest
AS
Department of Gynecology and Obstetrics, Hillerød Hospital, Hillerød, Denmark. asan@noh.regionh.dk
Berthelsen
Jørgen G
JG
Bergholt
Thomas
T
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage*; D002585:Cesarean Section / Q000706:statistics & numerical data; D017985:Dalteparin / Q000008:administration & dosage; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005865:Gestational Age; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy* / Q000517:prevention & control; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D000078222:Tinzaparin; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000517:prevention & control
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D000078222:Tinzaparin; D017985:Dalteparin