title: Incidence of hypersensitivity skin reactions in patients on full-dose low-molecular-weight heparins during pregnancy.
abstract: BACKGROUND
  Low-molecular-weight heparins (LMWH) are the most commonly used anticoagulants for the treatment and prophylaxis of venous thromboembolism in pregnancy. Hypersensitivity skin reactions associated with the use of LMWH are frequently seen, but are probably underreported.
  
  
  OBJECTIVE
  To evaluate the incidence of hypersensitivity skin reactions due to the use of LMWH in pregnancy, and the subsequent management of anticoagulation.
  
  
  METHODS
  From 1999 to 2009, we followed consecutive women who used therapeutic anticoagulation for venous indications. Women visited a combined obstetric/coagulation clinic and were seen by a thrombosis specialist every two months until six weeks postpartum. All women were started on nadroparin.
  
  
  RESULTS
  We included 135 pregnancies in 88 women. Overall, in 52 of 135 pregnancies (39%), women switched at least once to another anticoagulant because of the development of hypersensitivity skin reactions. Switching to another preparation of LMWH was effective in 77% of the cases. In 23% of the cases skin reactions recurred and another switch had to be made.
  
  
  CONCLUSIONS
  In almost half of the pregnancies, women had to switch at least once to another anticoagulant preparation due to the development of hypersensitivity skin reactions on LMWH. In most cases, skin reactions did not recur on the second preparation of LMWH used.
authors.affiliation: Division of Haemostasis and Thrombosis, Department of Haematology, University of Groningen, University Medical Centre Groningen, the Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Schultinge
authors.forename: H M
authors.initials: HM
authors.lastname: Knol
authors.forename: H C
authors.initials: HC
authors.lastname: Kluin-Nelemans
authors.forename: J J H M
authors.initials: JJ
authors.lastname: Erwich
authors.forename: K
authors.initials: K
authors.lastname: Meijer
mesh_terms: D000328:Adult; D000485:Allergens / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D005865:Gestational Age; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D009426:Netherlands; D010298:Parity; D049590:Postpartum Period; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control*; D012008:Recurrence; D012882:Skin Tests; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000485:Allergens; D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight