Abstract
Introduction
Pregnant women have a higher risk of developing deep vein thrombosis (DVT) and consequent thrombogenic events, including pulmonary embolisms. Low-molecular-weight heparin (LMWH) products have been shown to successfully treat DVT with few significant side effects. The purpose of this study was to compare the effects of two dose regimens of enoxaparin (a LMWH) in the management of DVT in pregnancy.
Methods
A total of 35 pregnant patients with DVT were enrolled in this study. As first-line anticoagulation therapy, patients were administered an intravenous unfractionated heparin infusion for 5 days, followed by a subcutaneous injection of enoxaparin 1 mg/kg twice a day until discharge. The enoxaparin therapy continued at home with 1 mg/kg twice a day for 18 patients (group I) and 1.5 mg/kg once a day for the other 17 patients (group II). Enoxaparin was discontinued 12–24 hours before delivery and restarted within 8-12 hours after delivery. Warfarin was given as adjuvant therapy along with enoxaparin in the post-partum period. Enoxaparin was discontinued when an international normalised ratio of 2 or above was reached. Differences between the two groups in terms of therapy response, complications and efficacy were recorded.
Results
Thrombophilic disease was observed in three patients in each group. The iliac vein had the highest incidence of DVT in both groups. During therapy, two patients in group I were diagnosed with a mild haemorrhage; one patient (in group II) had abortion. There were no significant differences between groups in terms of recanalisation (measured by venous ultrasonography examination), post-thrombotic symptoms or safety parameters.
Conclusion
Enoxaparin can be used safely in DVT therapy during pregnancy. Our results indicate that therapy consisting of a single daily dose of 1.5 mg/kg enoxaparin is as effective as twice-daily administration.
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References
Pillny M, Sandmann W, Luther B, et al. Deep venous thrombosis during pregnancy and after delivery: indications for and results of thrombectomy. J Vasc Surg. 2003;37:528–532.
Segal JB, Streiff MB, Hofmann LV, Thornton K, Bass EB. Management of venous thromboembolism: a systematic review for a practice guideline. Ann Intern Med. 2007;146:211–222.
Snow V, Qaseem A, Barry P, et al. The Joint American College of Physicians/American Academy of Family Physicians Panel on Deep Venous Thrombosis/Pulmonary Embolism. Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Fam Med. 2007;5:74–80.
James AH. Prevention and management of venous thromboembolism in pregnancy. Am J Med. 2007;120:S26–S34.
Ray JG, Chan WS. Deep vein thrombosis during pregnancy and the puerperium: a meta-analysis of the period of risk and the leg of presentation. Obstet Gynecol Surv. 1999;54:265–271.
James AH, Abel DE, Brancazio LR. Anticoagulants in pregnancy. Obstet Gynecol Surv. 2006;61:59–69.
Many A, Koren G. Low-molecular-weight heparins during pregnancy. Can Fam Physician. 2005;51:199–201.
Ginsberg JS, Bates SM. Management of venous thromboembolism during pregnancy. J Thromb Haemost. 2003;1:1435–1442.
Bremme KA. Haemostatic changes in pregnancy. Best Pract Res Clin Haematol. 2003;16:153–168.
Greer IA. Venous thromboembolism and anticoagulant therapy in pregnancy. Gend Med. 2005;2(suppl A):S10–S17.
Greer IA. Anticoagulants in pregnancy. J Thromb Thrombolysis. 2006;21:57–65.
McColl MD, Ramsay JE, Tait RC, et al. Risk factors for pregnancy associated venous thromboembolism. Thromb Haemost. 1997;78:1183–1188.
Bates SM, Greer IA, Hirsh J, Ginsberg JS. Use of antithrombotic agents during pregnancy: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126:627S–644S.
Eldor A. The use of low-molecular-weight heparin for the management of venous thromboembolism in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2002;104:3–13.
Ulander VM, Stenqvist P, Kaaja R. Treatment of deep venous thrombosis with low-molecular-weight heparin during pregnancy. Thromb Res. 2002;106:13–17.
Horlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg Anesth Pain Med. 2003;28:172–197.
Lindhagen A, Bergqvist A, Bergqvist D, Hallböök T. Late venous function in the leg after deep venous thrombosis occurring in relation to pregnancy. Br J Obstet Gynaecol. 1986;93:348–352.
Turpie AG, Chin BS, Lip GY. Venous thromboembolism: treatment strategies. BMJ. 2002;325:948–950.
Ellison J, Walker ID, Greer IA. Antenatal use of enoxaparin for prevention and treatment of thromboembolism in pregnancy. Br J Obstet Gynaecol. 2000;107:1116–1121.
Lagrange F, Brun JL, Vergnes MC, et al. Fondaparinux sodium does not cross the placental barrier: study using the in-vitro human dually perfused cotyledon model. Clin Pharmacokinet. 2002;41:47–49.
Hassn A, Hassan AM. Treatment with low molecular weight heparin needs anticoagulation monitoring. J Am Coll Surg. 1999;189:141–142.
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Narin, C., Reyhanoglu, H., Tülek, B. et al. Comparison of different dose regimens of enoxaparin in deep vein thrombosis therapy in pregnancy. Adv Therapy 25, 585–594 (2008). https://doi.org/10.1007/s12325-008-0068-0
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DOI: https://doi.org/10.1007/s12325-008-0068-0