Document Detail

Prophylaxis with low-dose low-molecular-weight heparin during pregnancy and postpartum: is it effective?
MedLine Citation:
PMID:  21232006     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The optimal approach for venous thrombosis (VTE) prophylaxis during pregnancy and postpartum in women with an increased risk of VTE is not established.
OBJECTIVES: To evaluate the effectiveness, represented as the incidence of pregnancy-related VTE, and safety, represented as incidence of postpartum hemorrhage (PPH), of a protocol recommending prophylaxis with low-dose low-molecular-weight heparin (LMWH) in women at intermediate to high risk of VTE.
PATIENTS/METHODS: In this retrospective cohort study, we analyzed 34 women (44 pregnancies) with intermediate risk of VTE who received low-dose LMWH for 6 weeks postpartum and 57 women (82 pregnancies) with high risk of VTE who received low-dose LMWH during pregnancy and for 6 weeks postpartum. Pregnancy-related VTE was defined as VTE during pregnancy or ≤ 3 months postpartum. PPH was defined as blood loss >500 mL and severe PPH as blood loss > 1000 mL.
RESULTS: The incidence of pregnancy-related VTE was 5.5% (95% CI, 2.4-12.3) despite prophylaxis with low-dose LMWH. All events occurred in women at high risk, with a postpartum incidence of 7.0% (95% CI, 2.9-16.7) and antepartum incidence of 1.8% (95% CI, 0.4-9.2). The risk of PPH was 21.6% (95% CI, 14.3-31.3) and severe PPH 9.1% (95% CI, 4.7-16.9), which was not different in women who started LMWH postpartum and those who used LMWH during pregnancy.
CONCLUSIONS: Although prophylaxis with low-dose LMWH during pregnancy and postpartum proved to be safe, the risk of pregnancy-related VTE is considerable in women with a high risk of VTE. VTE prophylaxis with low-dose LMWH may not be sufficiently effective in these women.
J E Roeters van Lennep; E Meijer; F J C M Klumper; J M Middeldorp; K W M Bloemenkamp; S Middeldorp
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  9     ISSN:  1538-7836     ISO Abbreviation:  J. Thromb. Haemost.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-01     Completed Date:  2011-06-21     Revised Date:  2011-11-03    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  England    
Other Details:
Languages:  eng     Pagination:  473-80     Citation Subset:  IM    
Copyright Information:
© 2011 International Society on Thrombosis and Haemostasis.
Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
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MeSH Terms
Anticoagulants / adverse effects,  pharmacology
Cohort Studies
Heparin, Low-Molecular-Weight / adverse effects,  pharmacology*
Postpartum Hemorrhage / etiology
Pregnancy Complications, Cardiovascular / prevention & control*
Puerperal Disorders / prevention & control
Retrospective Studies
Risk Factors
Venous Thromboembolism / complications,  prevention & control
Reg. No./Substance:
0/Anticoagulants; 0/Heparin, Low-Molecular-Weight
Comment In:
J Thromb Haemost. 2011 Jun;9(6):1269-71; author reply 1272-3   [PMID:  21489132 ]
J Thromb Haemost. 2011 Aug;9(8):1669-70   [PMID:  21645230 ]
J Thromb Haemost. 2011 Oct;9(10):2127-9; author reply 2129-30   [PMID:  21736699 ]

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