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A less-intensive anticoagulation protocol of therapeutic unfractionated heparin administration for pregnant patients

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Abstract

Heparin anticoagulant therapy for thromboembolic disorders during pregnancy is problematic due to unexpected adverse bleeding. To avoid bleeding, we have used a less-intensive anticoagulation protocol of unfractionated heparin (UFH). The protocol had a therapeutic activated partial thromboplastin time (APTT) ratio of 1.5–2.0 with the control value, a UFH dose of ≤ 30,000 U/day, and an antithrombin (AT) activity target of ≥ 70%. In the present study, we evaluated this protocol using an anti-Xa assay. We collected UFH-treated plasma samples from ten consecutive pregnant Japanese patients with current or previous thromboembolic disorders. Seven patients remained in the therapeutic APTT ratio range (heparin-sensitive [HS] group). The other three patients had difficulty remaining within the therapeutic range (heparin-resistant [HR] group). In the HR group, two had AT deficiency and one had congenital absence of the inferior vena cava. Of the HS and HR samples, 73% and 31%, respectively, were within the therapeutic anti-Xa activity range 0.3–0.7 U/mL, indicating difficulty for the HR group to remain within the therapeutic range. Neither major bleeding nor symptomatic thromboembolic episodes occurred in either group. These findings suggest that the less-intensive anticoagulation protocol is permissive and may be beneficial in the HS group.

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Acknowledgements

This study was supported in part by grants-in-aid from a Japan Society for the Promotion of Science KAKENHI grant (#JP18K09277), the Takeda Science Foundation, and the Intramural Research Fund of the National Cerebral and Cardiovascular Center of Japan (grants #23-6-8, #25-6-8, #27-6-27).

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Authors and Affiliations

  1. Division of Counseling for Medical Genetics, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan

    Reiko Neki & Kazufumi Ida

  2. Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan

    Reiko Neki, Takekazu Miyoshi, Chizuko Kamiya, Naoko Iwanaga & Jun Yoshimatsu

  3. Laboratory of Clinical Chemistry, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan

    Mana Mitsuguro & Akira Okamoto

  4. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan

    Toshiyuki Miyata

Authors
  1. Reiko Neki
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  2. Mana Mitsuguro
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  3. Akira Okamoto
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  4. Kazufumi Ida
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  5. Takekazu Miyoshi
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  6. Chizuko Kamiya
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  7. Naoko Iwanaga
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  8. Toshiyuki Miyata
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  9. Jun Yoshimatsu
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Correspondence to Reiko Neki.

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Neki, R., Mitsuguro, M., Okamoto, A. et al. A less-intensive anticoagulation protocol of therapeutic unfractionated heparin administration for pregnant patients. Int J Hematol 110, 550–558 (2019). https://doi.org/10.1007/s12185-019-02712-z

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  • DOI: https://doi.org/10.1007/s12185-019-02712-z

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