J Ellison1, I D Walker, I A Greer. 1. University Department of Obstetrics and Gynaecology, Glasgow Royal Maternity Hospital and Glasgow Royal Infirmary, UK.
Abstract
OBJECTIVE: To assess the safety and efficacy of enoxaparin use for thromboprophylaxis or treatment of venous thromboembolism during pregnancy. DESIGN: Retrospective review of casenotes of women who received enoxaparin during pregnancy. SETTING: Obstetric Medicine Unit at Glasgow Royal Maternity Hospital. SAMPLE: Data were obtained on 57 pregnancies in 50 women over six years. METHODS: Information was obtained from case records in relation to outcome measures, the presence of underlying thrombophilia and indication for anticoagulation. MAIN OUTCOME MEASURES: Incidences of venous thromboembolism, haemorrhage, thrombocytopenia, peak plasma anti-factor Xa levels and symptomatic osteoporosis. RESULTS: There were no thromboembolic events in the thromboprophylaxis group. There were no incidences of heparin-induced thrombocytopenia. Twenty-two women had spinal or epidural anaesthesia and no complications were encountered. There was one instance of antepartum haemorrhage following attempted amniotomy in a woman with previously unknown vasa praevia. Two women sustained postpartum haemorrhage, both secondary to vaginal lacerations, resulting in blood loss > 1,000 mL. Blood loss following caesarean section was not excessive. No instances of vertebral or hip fracture were encountered. The median peak plasma anti-factor Xa level on a dose of 40 mg once daily was 0.235 U/mL; peak plasma anti-factor Xa levels were not affected by gestational age. CONCLUSIONS: The use of enoxaparin in pregnancy is associated with a low incidence of complications and a dose of 40 mg once daily throughout pregnancy provides satisfactory anti-factor Xa levels and appears effective in preventing venous thromboembolism.
OBJECTIVE: To assess the safety and efficacy of enoxaparin use for thromboprophylaxis or treatment of venous thromboembolism during pregnancy. DESIGN: Retrospective review of casenotes of women who received enoxaparin during pregnancy. SETTING: Obstetric Medicine Unit at Glasgow Royal Maternity Hospital. SAMPLE: Data were obtained on 57 pregnancies in 50 women over six years. METHODS: Information was obtained from case records in relation to outcome measures, the presence of underlying thrombophilia and indication for anticoagulation. MAIN OUTCOME MEASURES: Incidences of venous thromboembolism, haemorrhage, thrombocytopenia, peak plasma anti-factor Xa levels and symptomatic osteoporosis. RESULTS: There were no thromboembolic events in the thromboprophylaxis group. There were no incidences of heparin-induced thrombocytopenia. Twenty-two women had spinal or epidural anaesthesia and no complications were encountered. There was one instance of antepartum haemorrhage following attempted amniotomy in a woman with previously unknown vasa praevia. Two women sustained postpartum haemorrhage, both secondary to vaginal lacerations, resulting in blood loss > 1,000 mL. Blood loss following caesarean section was not excessive. No instances of vertebral or hip fracture were encountered. The median peak plasma anti-factor Xa level on a dose of 40 mg once daily was 0.235 U/mL; peak plasma anti-factor Xa levels were not affected by gestational age. CONCLUSIONS: The use of enoxaparin in pregnancy is associated with a low incidence of complications and a dose of 40 mg once daily throughout pregnancy provides satisfactory anti-factor Xa levels and appears effective in preventing venous thromboembolism.
Authors: Lori-Ann Linkins; Antonio L Dans; Lisa K Moores; Robert Bona; Bruce L Davidson; Sam Schulman; Mark Crowther Journal: Chest Date: 2012-02 Impact factor: 9.410
Authors: Michał Ciurzyński; Krzysztof Jankowski; Bronisława Pietrzak; Natalia Mazanowska; Ewa Rzewuska; Robert Kowalik; Piotr Pruszczyk Journal: Med Sci Monit Date: 2011-05