Low molecular weight heparin: a promising anticoagulant in pregnancy

Vidyadhar B. Bangal, Purushottam A. Giri, Shravani Chalasani, Denita Fernandes

Abstract


Venous thromboembolism (VTE) is a leading cause of maternal mortality and morbidity during pregnancy in developed countries. The incidence of VTE increases about 4-fold during pregnancy and at least 14-fold during the puerperium. Risk factors include a personal history of VTE, presence of inherited or acquired thrombophilia, a family history of VTE and general medical conditions, such as immobilisation, overweight, varicose veins, some haematological diseases and inflammatory disorders. VTE is considered potentially preventable with the prophylactic administration of anticoagulants. Low molecular weight heparin has emerged as choice of anticoagulant in the present day obstetric and infertility practice. It has many advantages over unfractionated heparin and warfarin. Longer duration of action, less frequent dosing schedule, better safety profile are few of the advantages. Higher cost as compared to warfarin and unfractionated heparin is the main limiting factor for its use.


Keywords


Low molecular weight heparin, Anticoagulants in pregnancy, Venous thromboembolism, Heparin induced thrombocytopenia

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References


Barbour LA. Current concept of anticoagulant therapy in Pregnancy. Obstet Gynaecol Clin N Am. 1997;24(3):499-521.

Heilmann I, Schneider DM. Anti-thrombotic therapy in high risk pregnancy. Haematol Oncol Clin N Am. 2000;14(5):1133-50.

Mccoll MD, Ramsay JE, Tait RC. Risk factors for pregnancy associated venous thromboembolism. Thromb Haemost. 1997;82(2):620-5.

Ginsberg JS. Thromboembolism and pregnancy. Thromb Haemost. 1999;82(2):620-5.

Dimitrakakis C, Papageorgiou P, Antzaklis A. Absence of transplacental passage of the low molecular weight heparin enoxaparin. Haemostasis. 2000;30(5):243-8.

Brenner B, Hoffman R, Bluemenfeld Z, Weiner Z, Younis JS. Gestational outcome in thrombophilic woman with recurrent pregnancy loss treated by enoxaparin. Thromb Haemost. 2000;83(5):693-7.

Bar J, Mashiah R. Effect of thrombo prophylaxis on uterine and fetal circulation in pregnant women with a history of pregnancy complications. Thromb Res. 2001;101(4):235-41.

Robin F, Lecuru F, Desfeux P, Boucaya V, Taurelle R. Anticoagulant therapy in pregnancy. Eur J Obstet Gynaecol Reprod Biol. 1999;83(20):171-7.

Zakzouk MS. The congenital warfarin syndrome. J Laryngol Otol. 1986;100:215-9.

Giradi G, Redecha P, Salmon JE. Heparin prevents antiphospholipid antibody induced fetal loss by inhibiting complement activation. Nat Med. 2004;10(11):1222-6.

Robin F, Lecuru F, Desfeux P, Boucaya V, Taurelle R. Anticoagulant therapy in pregnancy. Eur J Obstet Gynaecol Reprod Biol. 1999;83(2):171-7.

Pettila V, Kaaja R, Leinonen P, Ekblad U, Kataja M, Ikkala E. Thromboprophylaxis with low molecular heparin in pregnancy. Throm Res. 1999;96(4);275-82.

Sanson BJ, Lensing AW, Prins MH Ginsberg JS, Barkagan ZS, Lavenne-Pardonge E, et al. Safety of low molecular weight heparin in pregnancy: a systematic review. Thromb Haemost. 1999;81(5):668-72.

Mellissari E, Parkar CJ, Wilson NV, Monte G, Kanthou C, Pemberton KD, et al. Use of low molecular weight heparin in pregnancy. Thromb Haemost. 1992;68(6):652-6.

Deruelle P, Denervaud M, Hachulla E, Ducloy-Bouthors AS, Valat AS, Puech F, et al. Use of Low molecular weight heparin from first trimester of pregnancy. Eur J Obstet Gynaecol Reprod Biol. 2006;127:73-8.

Gullermina Gilardi. Heparin treatment in Pregnancy loss: potential therapeutic benefits beyond anticoagulation. J Reprod Immunol. 2005;66:45-51.

Nimes Obstetricians and Hematologists. Abruptio placentae (NOH-AP) trial. Thromb Haemost. 2010 Oct;104(4):771-9.

Brenner B, Hoffman R, Blumenfeld Z, Weiner Z, Younis JS. Gestational outcome in thrombophilic women with recurrent pregnancy loss treated by enoxaparin. Thromb Haemost. 2000;83(5):693-7.

Glueck CJ, Pranikoff J, Khan N, Riaz K, Chavan K, Raj P, et al. High factor XI and recurrent pregnancy loss, enoxaparin. Fertil Steril. 2010;94(7):2828-31.

Watanabe T, Matsubara S, Usui R, Izumi A, Kuwata T, Suzuki M. No increase in hemorrhagic complications with thromboprophylaxis using low-molecular-weight heparin soon after caesarean section. J Obstet Gynaecol Res. 2011 Sep;37(9):1208-11.

Fouda UM, Sayed AM, Abdou AM, Ramadan DI, Fouda IM, Zaki MM. Enoxaparin versus fractionated heparin in recurrent abortion secondary to antiphospholipid syndrome. Int J Gynaecol Obstet. 2011;112:211-5.

Basude S, Hein C, Curtis SL, Clark A, Trinder J. Low-molecular-weight heparin or warfarin for anticoagulation in pregnant women with mechanical heart valves: what are the risks? A retrospective observational study. BJOG. 2012;119(8):1008-13.

Ghosh K, Shetty S, Vora S, Salvi V. Successful pregnancy outcome in women with bad obstetric history and recurrent fetal loss due to thrombophilia: effect of unfractionated heparin and low-molecular weight heparin. Clin Appl Thromb Hemost. 2008 Apr;14(2):174-9.

Deruelle P, Denervaud M, Hachulla E, Ducloy-Bouthors AS, Valat AS, Puech F, et al. Use of low-molecular-weight heparin from the first trimester of pregnancy: a retrospective study of 111 consecutive pregnancies. Eur J Obstet Gynaecol Reprod Biol. 2006;127:73-8.