BJOG : an international journal of obstetrics and gynaecology · 2000
Antenatal use of enoxaparin for prevention and treatment of thromboembolism in pregnancy.
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Ellison J, Walker I D, Greer I A
Аннотация
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.
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.