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Journal of Thrombosis and Thrombolysis

, Volume 43, Issue 1, pp 105–111 | Cite as

Adjustment of therapeutic LMWH to achieve specific target anti-FXa activity does not affect outcomes in pregnant patients with venous thromboembolism

  • Brendan P. McDonnell
  • Kate Glennon
  • Aoife McTiernan
  • Hugh D. O’Connor
  • Colin Kirkham
  • Barry Kevane
  • Jennifer C. Donnelly
  • Fionnuala Ni Áinle
Article

Abstract

Venous thromboembolism (VTE) remains a leading cause of maternal morbidity and mortality in the developed world. Low molecular weight heparins (LMWH) are routinely used to provide therapeutic anticoagulation during pregnancy for women with VTE, with measurement of plasma anti-FXa activity used to guide dosing in certain patient groups. There is limited evidence to support the use of anti-FXa monitoring in pregnant patients. This study seeks to ascertain whether anti-FXa monitoring of pregnant patients with VTE influences patient outcomes. We performed a single-centre case series including two consecutive groups of pregnant patients treated with LMWH for VTE sustained in the index pregnancy with and without monitoring of anti-FXa levels. 35,394 patients delivered during the study period in a large urban stand-alone maternity hospital, with 26 cases of VTE eligible for inclusion. There was no significant difference between the two groups in any clinical outcome; including maternal blood loss at delivery, recurrent thromboembolic events or rates of planned delivery. These data provide clinical evidence to support current international guideline recommendations that measurement of plasma anti-FXa activity in the majority of patients receiving therapeutic-intensity antenatal LMWH is not warranted.

Keywords

Factor Xa Low molecular weight heparin Pregnancy Tinzaparin Venous thrombosis 

Notes

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Brendan P. McDonnell
    • 1
  • Kate Glennon
    • 1
  • Aoife McTiernan
    • 1
  • Hugh D. O’Connor
    • 1
  • Colin Kirkham
    • 1
  • Barry Kevane
    • 2
  • Jennifer C. Donnelly
    • 1
  • Fionnuala Ni Áinle
    • 2
    • 3
    • 4
  1. 1.Department of ObstetricsRotunda HospitalDublin 1Ireland
  2. 2.Department of HematologyRotunda HospitalDublin 1Ireland
  3. 3.Department of HematologyMater Misericordiae University HospitalDublin 7Ireland
  4. 4.School of Medicine and Medical SciencesUniversity College DublinDublin 4Ireland

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