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Low molecular weight heparins use in pregnancy: a practice survey from Greece and a review of the literature.
Thromb J 2019; 17:23TJ

Abstract

Background

Use of LMWH in pregnancy is not only limited to VTE management, but it extends, to the management of vascular gestational complications and the optimization of IVF pregnancies despite the lack of concrete scientific evidence. In this context, we conducted the present study aiming to gain insights regarding the use of LMWH during pregnancy and puerperium. We recorded indication for use, diagnostic work-up as well as the safety and efficacy of the treatment, trying to elucidate the clinical practice in our country.

Methods

We analyzed data regarding 818 pregnant women received LMWH during 2010-2015.Our cohort had a median age of 33.9 years and a BMI of 23.6.There were 4 groups: those with a history of VTE [Group-A: 76], those with pregnancy complications [Group-B: 445], those undergoing IVF [Group-C: 132] and those carrying prothrombotic tendency (thrombophilia, family history of VTE, other) [Group-D: 165]. Mean duration of LMWH administration was 8.6 ± 1.5 months. Out of the total number, 440 received LMWH in fixed prophylactic dose, 272 in higher prophylactic-weight adjusted dose and 106 in therapeutic dose. Moreover, 152 women received in addition low-dose acetylsalicylic acid (ASA). 93.8% of pregnancies were single and 6.2% were multiple ones. Live births occurred in 98.7% of pregnancies.

Results

Anticoagulation was efficacious and well tolerated. Seventeen VTE events were recorded; 7 of them antepartum and 10 postpartum. No major bleeding events were observed while 13 clinical relevant non-major bleeding events were recorded. Regarding gestational vascular complications, 28 IUGR events were recorded, as well as 48 cases of preterm labor of which 12 were concomitant with IUGR (25%). Six early pregnancy losses were recorded; there were 3 fetal deaths and 3 cases of pre-eclampsia/eclampsia.

Conclusions

LMWHs are used extensively during pregnancy and puerperium in Greece for VTE treatment and prophylaxis and for a variety of other indications as well. Although the drug has been shown to be both safe and efficacious, its use for some indications has no proven scientific evidence. In order to clearly define the role of LMWHs in pregnancy, beyond thromboprophylaxis, large prospective studies are required, which could be based on the conclusions of this study.

Authors+Show Affiliations

1Hemostasis Unit-Hematology Department Papageorgiou Hospital, Thessaloniki Ringroad 56403 Nea Efkarpia, Thessaloniki, Greece.22nd Department of Pathology, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1 Haidari, Athens, Greece.OLYMPION General Clinic, Volou-Patras, 26443 Patras, Greece.4University Hospital of Alexandroupolis, Dragana Site 68100 Nea Chili, Alexandroupoli, Greece.5Blood Transfusion Unit, National Ref. Centre for Congenital Bleeding Disorders, Hemostasis Unit, Laiko General Hospital, Ag. Thoma, 17 11527 Athens, Greece.6Head of Transfusion Service and Clinical Haemostasis, Henry Dunant Hospital Center, Mesogion 107, 115 26 Athens, Greece.IASO, General Maternity and Gynecology Clinic, 37-39, Kifissias Avenue, 151 23 Maroussi, Athens, Greece."St Savvas" Oncology Hospital, Alexandras Avenue 171, 11522 Ambelikipoi, Athens, Greece.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31827408

Citation

Papadakis, E, et al. "Low Molecular Weight Heparins Use in Pregnancy: a Practice Survey From Greece and a Review of the Literature." Thrombosis Journal, vol. 17, 2019, p. 23.
Papadakis E, Pouliakis A, Aktypi Α, et al. Low molecular weight heparins use in pregnancy: a practice survey from Greece and a review of the literature. Thromb J. 2019;17:23.
Papadakis, E., Pouliakis, A., Aktypi, Α., Christoforidou, A., Kotsi, P., Αnagnostou, G., ... Grouzi, E. (2019). Low molecular weight heparins use in pregnancy: a practice survey from Greece and a review of the literature. Thrombosis Journal, 17, p. 23. doi:10.1186/s12959-019-0213-9.
Papadakis E, et al. Low Molecular Weight Heparins Use in Pregnancy: a Practice Survey From Greece and a Review of the Literature. Thromb J. 2019;17:23. PubMed PMID: 31827408.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low molecular weight heparins use in pregnancy: a practice survey from Greece and a review of the literature. AU - Papadakis,E, AU - Pouliakis,A, AU - Aktypi,Α, AU - Christoforidou,A, AU - Kotsi,P, AU - Αnagnostou,G, AU - Foifa,A, AU - Grouzi,E, Y1 - 2019/12/04/ PY - 2019/04/23/received PY - 2019/11/25/accepted PY - 2019/12/13/entrez PY - 2019/12/13/pubmed PY - 2019/12/13/medline KW - Low molecular weight heparin KW - Pregnancy KW - Pregnancy complications KW - Venous thromboembolism SP - 23 EP - 23 JF - Thrombosis journal JO - Thromb J VL - 17 N2 - Background: Use of LMWH in pregnancy is not only limited to VTE management, but it extends, to the management of vascular gestational complications and the optimization of IVF pregnancies despite the lack of concrete scientific evidence. In this context, we conducted the present study aiming to gain insights regarding the use of LMWH during pregnancy and puerperium. We recorded indication for use, diagnostic work-up as well as the safety and efficacy of the treatment, trying to elucidate the clinical practice in our country. Methods: We analyzed data regarding 818 pregnant women received LMWH during 2010-2015.Our cohort had a median age of 33.9 years and a BMI of 23.6.There were 4 groups: those with a history of VTE [Group-A: 76], those with pregnancy complications [Group-B: 445], those undergoing IVF [Group-C: 132] and those carrying prothrombotic tendency (thrombophilia, family history of VTE, other) [Group-D: 165]. Mean duration of LMWH administration was 8.6 ± 1.5 months. Out of the total number, 440 received LMWH in fixed prophylactic dose, 272 in higher prophylactic-weight adjusted dose and 106 in therapeutic dose. Moreover, 152 women received in addition low-dose acetylsalicylic acid (ASA). 93.8% of pregnancies were single and 6.2% were multiple ones. Live births occurred in 98.7% of pregnancies. Results: Anticoagulation was efficacious and well tolerated. Seventeen VTE events were recorded; 7 of them antepartum and 10 postpartum. No major bleeding events were observed while 13 clinical relevant non-major bleeding events were recorded. Regarding gestational vascular complications, 28 IUGR events were recorded, as well as 48 cases of preterm labor of which 12 were concomitant with IUGR (25%). Six early pregnancy losses were recorded; there were 3 fetal deaths and 3 cases of pre-eclampsia/eclampsia. Conclusions: LMWHs are used extensively during pregnancy and puerperium in Greece for VTE treatment and prophylaxis and for a variety of other indications as well. Although the drug has been shown to be both safe and efficacious, its use for some indications has no proven scientific evidence. In order to clearly define the role of LMWHs in pregnancy, beyond thromboprophylaxis, large prospective studies are required, which could be based on the conclusions of this study. SN - 1477-9560 UR - https://www.unboundmedicine.com/medline/citation/31827408/Low_molecular_weight_heparins_use_in_pregnancy:_a_practice_survey_from_Greece_and_a_review_of_the_literature L2 - https://thrombosisjournal.biomedcentral.com/articles/10.1186/s12959-019-0213-9 DB - PRIME DP - Unbound Medicine ER -