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A descriptive evaluation of unfractionated heparin use during pregnancy

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Abstract

Background The mainstay of oral anticoagulant therapy, warfarin sodium, crosses the placenta during pregnancy and may cause fetal complications. Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) do not cross the placenta and have demonstrated utility in the prevention and treatment of thrombosis during pregnancy. Objectives The purpose of this study was to review treatment strategy, indication, and maternal and fetal outcomes in anticoagulated pregnancies at Kaiser Permanente Colorado. Patients/Methods We identified 103 pregnancies in 93 mothers prescribed an anticoagulant during a pregnancy occurring between January 1, 1998 and March 31, 2005. Results The majority of patients were treated with UFH (89.3%). Indications for anticoagulation included venous thromboembolism (VTE) prophylaxis (53.4%), history of pregnancy loss (29.1%), acute VTE (16.5%), and history of cerebral vascular accident (CVA) (1.0%). There were no maternal deaths. Fetal demise occurred in 8 pregnancies (7.8%) at a median 14 weeks gestation (range 7–22 weeks). No fetal demise occurred in pregnancies treated for acute VTE or history of CVA. There were two occurrences of pulmonary embolism (1.9%) and two hemorrhagic events requiring transfusion (1.9%). Conclusions Maternal and fetal adverse events were infrequent in our population of anticoagulated pregnancies. UFH remains a viable option among more expensive LMWH products.

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Acknowledgements

We would like to acknowledge the KPCO Pharmacy Dept. and its Executive Director, Dennis Helling, PharmD, for their support of this study. This study was funded entirely by Kaiser Permanente Colorado. This study partially was undertaken in fulfillment of the requirements for Suzanne Parker’s American Society of Health-Systems Pharmacy residency program.

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Authors and Affiliations

  1. Clinical Pharmacy Anticoagulation Service, Kaiser Permanente Colorado, 280 Exempla Circle, Lafayette, CO, 80026, USA

    Nathan P. Clark, Thomas Delate, Daniel M. Witt & Suzanne Parker

  2. Department of Obstetrics and Gynecology, Colorado Permanente Medical Group, 2045 Franklin St., Denver, CO, 80205, USA

    Robert McDuffie

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  1. Nathan P. Clark
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  2. Thomas Delate
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  4. Suzanne Parker
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Correspondence to Nathan P. Clark.

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Clark, N.P., Delate, T., Witt, D.M. et al. A descriptive evaluation of unfractionated heparin use during pregnancy. J Thromb Thrombolysis 27, 267–273 (2009). https://doi.org/10.1007/s11239-008-0207-0

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  • DOI: https://doi.org/10.1007/s11239-008-0207-0

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