Document Detail


Efficacy and safety of once daily low molecular weight heparin (tinzaparin sodium) in high risk pregnancy.
MedLine Citation:
PMID:  18832911     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Low molecular weight heparin (LMWH) is widely regarded as the anticoagulant treatment of choice for the prevention and treatment of venous thromboembolism during pregnancy. However, previous studies have demonstrated that the pharmacokinetic profiles of LMWH vary significantly with increasing gestation. Consequently, it remains unclear whether LMWH regimens recommended for use in nonpregnant individuals can be safely extrapolated to pregnant women. The aims of this study were to assess the safety and the efficacy of tinzaparin sodium (Innohep) administered only once daily during pregnancy. A systematic retrospective review identified a cohort of 37 high-risk pregnancies which had been managed using tinzaparin 175 IU/kg once daily. In 26 cases, the index pregnancy had been complicated by development of an acute venous thromboembolism (17 deep vein thrombosis and nine pulmonary embolism). For each individual, case notes were examined and data extracted using a predetermined questionnaire. No episodes of recurrent venous thromboembolism were identified amongst this cohort of pregnancies managed using once daily LMWH administration. However, two unusual thrombotic complications were observed, including a parietal infarct in one patient, and a postpartum cerebral venous thrombosis in another. Once daily tinzaparin was well tolerated, with no cases of heparin-induced thrombocytopaenia, symptomatic osteoporosis, or foetal malformations. Tinzaparin dose modification based upon peak anti-Xa levels occurred in 45% of the cases examined. The present study is the largest study to have examined the clinical efficacy of once daily LMWH for use in pregnant women at high risk of venous thromboembolism. Our data support the safety and efficacy of antenatal tinzaparin at a dose of 175 IU/kg. In order to determine whether this once daily regimen provides equivalent (or indeed greater) thromboprophylaxis to twice daily LMWH regimens during pregnancy will require highly powered direct comparative studies.
Authors:
Fionnuala Ní Ainle; Audris Wong; Niamh Appleby; Brigitte Byrne; Carmen Regan; Tayyaba Hassan; Marie Milner; Ann O Sullivan; Barry White; James O'Donnell
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis     Volume:  19     ISSN:  0957-5235     ISO Abbreviation:  Blood Coagul. Fibrinolysis     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-03     Completed Date:  2009-03-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9102551     Medline TA:  Blood Coagul Fibrinolysis     Country:  England    
Other Details:
Languages:  eng     Pagination:  689-92     Citation Subset:  IM    
Affiliation:
National Centre for Hereditary Coagulation Disorders, St James's Hospital, Ireland. jodonne@tcd.ie
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MeSH Terms
Descriptor/Qualifier:
Adult
Cohort Studies
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Fibrinolytic Agents / administration & dosage*,  adverse effects,  blood
Heparin, Low-Molecular-Weight / administration & dosage*,  adverse effects,  blood
Humans
Pregnancy
Pregnancy Complications, Hematologic / blood,  drug therapy,  prevention & control*
Pregnancy Outcome
Pregnancy, High-Risk
Retrospective Studies
Venous Thromboembolism / blood,  drug therapy,  prevention & control*
Young Adult
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Heparin, Low-Molecular-Weight; 0/tinzaparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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