Heparin-induced thrombocytopenia-alternative anticoagulation in pregnancy and lactation.

Heparin-induced thrombocytopenia (HIT) appears rarely in pregnant patients who are being treated with heparin. When HIT is suspected, heparin treatment should be discontinued and alternative anticoagulation should be started. The heparinoid danaparoid appears to be the drug of choice for acute treatment and prophylaxis because of its low placental permeability. Between the 12th and 36th weeks of pregnancy, either danaparoid may be continued or warfarin may be used after recovery of platelet counts. Before and during delivery, danaparoid should be preferred over warfarin in order to avoid bleeding complications in mother and infant. Hirudin should only be used when either cross-reactivity with heparin-induced antibodies or cutaneous allergy against heparinoids are observed. Postpartum warfarin seems to be the treatment of choice because breast-feeding can be continued. Alternative treatment with either danaparoid or hirudin is possible, but data on treatment with these reagents in lactating mothers are very limited.