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Low molecular weight heparin pregnancy

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https://www.readbyqxmd.com/read/27889133/-venous-thromboembolism-prevention-in-pregnancy-and-the-postpartum-period-in-primary-and-specialized-care
#1
J L Gallo-Vallejo, M Naveiro-Fuentes, A Puertas-Prieto, F J Gallo-Vallejo
After noting that there are a number of risk factors for venous thromboembolism disease during pregnancy, it emphasizes primary prevention and treatment of this serious condition during pregnancy and the postpartum period are essential to reduce maternal morbidity and mortality. Low molecular-weight heparins are under the anticoagulant of choice in pregnancy. Your prescription may make both the primary care physician, as the hematologist and obstetrician. As for prescribing terms, an application protocol in both primary and specialized, multidisciplinary care, based on the existing literature on the subject is presented, which indicated that the hypercoagulable disorders associated with some of the risk factors, forced to do thromboprophylaxis with low molecular-weight heparins throughout pregnancy and the postpartum period presented...
November 23, 2016: Semergen
https://www.readbyqxmd.com/read/27887785/thromboelastography-teg%C3%A2-demonstrates-that-tinzaparin-4500-international-units-has-no-detectable-anticoagulant-activity-after-caesarean-section
#2
S Griffiths, C Woo, V Mansoubi, A Riccoboni, A Sabharwal, S Napier, M Columb, M Laffan, G Stocks
BACKGROUND: Low molecular weight heparin is routinely used for thromboprophylaxis in pregnancy and the puerperium. Consensus guidelines recommend waiting 10-12h after administration of a thromboprophylactic dose of low molecular weight heparin before performing a neuraxial block or removing an epidural catheter. Thromboelastography (TEG®) has been reported to be sensitive to the effects of enoxaparin 4h after administration. The purpose of this study was to use TEG to examine coagulation changes in the first 10h after a thromboprophylactic dose of tinzaparin in an attempt to ratify the current consensus guidelines about timing of neuraxial blockade and epidural catheter removal...
October 8, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27876004/enoxaparin-for-the-prevention-of-preeclampsia-and-intrauterine-growth-restriction-in-women-with-a-prior-history-an-open-label-randomised-trial-the-eppi-trial-study-protocol
#3
K M Groom, L M McCowan, P R Stone, L C Chamley, C McLintock
BACKGROUND: Preeclampsia and intrauterine fetal growth restriction (IUGR) are two of the most common causes of maternal and perinatal morbidity and mortality. Current methods of predicting those at most risk of these conditions remain relatively poor, and in clinical practice past obstetric history remains the most commonly used tool. Aspirin and, in women at risk of preeclampsia only, calcium have been demonstrated to have a modest effect on risk reduction. Several observational studies and randomised trials suggest that low molecular weight heparin (LMWH) therapy may confer some benefit...
November 22, 2016: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/27848915/heparin-monitoring-clinical-outcome-and-practical-approach
#4
Noémie Despas, Anne-Sophie Larock, Hugues Jacqmin, Jonathan Douxfils, Bernard Chatelain, Marc Chatelain, François Mullier
Traditional anticoagulant agents such as unfractionated heparin (UFH), low molecular weight heparins (LMWHs), fondaparinux, danaparoid and bivalirudine are used in the prevention and treatment of thromboembolic diseases. However, these agents have limitations: their constraining parenteral route of administration and the need for regular coagulation monitoring for HNF. The LMWHs, with their more predictable anticoagulant response, don't require a systematic monitoring. The usefulness of LMWHs monitoring in several clinical situations such as pregnancy, obesity and renal insufficiency is a matter of debate...
December 1, 2016: Annales de Biologie Clinique
https://www.readbyqxmd.com/read/27829874/increased-unfractionated-heparin-requirements-with-decreasing-body-mass-index-in-pregnancy
#5
Avinash S Patil, Tracy Clapp, Piyamas K Gaston, David Kuhl, Eliza Rinehart, Norman L Meyer
BACKGROUND: Pregnant women receiving low-molecular-weight heparin for therapeutic anticoagulation are often converted to unfractionated heparin in anticipation of labor. We aim to characterize the impact of maternal body mass index on attainment of target anticoagulation during the conversion process. METHODS: We conducted a five-year retrospective study of a pregnancy cohort converted from low-molecular-weight heparin to unfractionated heparin in the third trimester...
December 2016: Obstetric Medicine
https://www.readbyqxmd.com/read/27816347/cerebral-venous-thrombosis
#6
José Manuel Ferro, Patrícia Canhão, Diana Aguiar de Sousa
Cerebral venous thrombosis (CVT) has an incidence of 1.32/100,000/years in high-income countries, and higher in middle- and low-income countries. CVT is more frequent in infants and children young adults and females, especially during pregnancy/puerperium. CVT are now being diagnosed with increasing frequency because of the increased awareness and higher use of magnetic resonance imaging (MR) for investigating patients with acute and subacute headaches and new onset seizures. CVT rarely present as a stroke syndrome...
November 2, 2016: La Presse Médicale
https://www.readbyqxmd.com/read/27803506/role-of-novel-oral-anticoagulants-in-the-treatment-of-antiphospholipid-syndrome
#7
C Whitney White, Angela R Thomason, Katie Boyd
Background: Antiphospholipid syndrome (APS) is an autoimmune disease characterized by thrombosis or pregnancy loss with persistent positive antibodies. Standard treatment for APS with history of thromboembolism is heparin or low-molecular-weight heparin followed by a vitamin K antagonist (VKA). Novel oral anticoagulants (NOACs) could be effective in patients with APS, but none carry indications for treatment related to APS. Clinical Evidence: Five case reports or series with rivaroxaban and dabigatran suggest thrombotic events occur most often in the higher risk population (arterial thrombosis and/or triple positive antibodies) or in patients who had recurrent VTEs on warfarin therapy...
October 2016: Hospital Pharmacy
https://www.readbyqxmd.com/read/27799851/low-molecular-weight-heparin-can-benefit-women-with-recurrent-pregnancy-loss-and-sole-protein-s-deficiency-a-historical-control-cohort-study-from-taiwan
#8
Ming-Ching Shen, Wan-Ju Wu, Po-Jen Cheng, Gwo-Chin Ma, Wen-Chu Li, Jui-Der Liou, Cheng-Shyong Chang, Wen-Hsiang Lin, Ming Chen
BACKGROUND: Heritable thrombophilias are assumed important etiologies for recurrent pregnancy loss. Unlike in the Caucasian populations, protein S and protein C deficiencies, instead of Factor V Lieden and Prothrombin mutations, are relatively common in the Han Chinese population. In this study we aimed to investigate the therapeutic effect of low molecular weight heparin upon women with recurrent pregnancy loss and documented protein S deficiency. METHODS: During 2011-2016, 68 women with recurrent pregnancy loss (RPL) and protein S deficiency (both the free antigen and function of protein S were reduced) were initially enrolled...
2016: Thrombosis Journal
https://www.readbyqxmd.com/read/27776934/the-antiphospholipid-syndrome-in-patients-with-systemic-lupus-erythematosus
#9
Guillermo J Pons-Estel, Laura Andreoli, Francesco Scanzi, Ricard Cervera, Angela Tincani
The antiphospholipid syndrome (APS) is an autoimmune disease characterized by the occurrence of venous and/or arterial thrombosis and pregnancy morbidity in the presence of pathogenic autoantibodies known as antiphospholipid antibodies (aPL). APS may be associated with other diseases, mainly systemic lupus erythematosus (SLE). The presence or absence of SLE might modify the clinical or serological expression of APS. Apart from the classical manifestations, APS patients with associated SLE more frequently display a clinical profile with arthralgias, arthritis, autoimmune hemolytic anemia, livedo reticularis, epilepsy, glomerular thrombosis, and myocardial infarction...
October 21, 2016: Journal of Autoimmunity
https://www.readbyqxmd.com/read/27720498/low-molecular-weight-heparin-for-pregnancy-complications
#10
Ian A Greer
No abstract text is available yet for this article.
October 6, 2016: Lancet
https://www.readbyqxmd.com/read/27720497/low-molecular-weight-heparin-and-recurrent-placenta-mediated-pregnancy-complications-a-meta-analysis-of-individual-patient-data-from-randomised-controlled-trials
#11
Marc A Rodger, Jean-Christophe Gris, Johanna I P de Vries, Ida Martinelli, Évelyne Rey, Ekkehard Schleussner, Saskia Middeldorp, Risto Kaaja, Nicole J Langlois, Timothy Ramsay, Ranjeeta Mallick, Shannon M Bates, Carolien N H Abheiden, Annalisa Perna, David Petroff, Paulien de Jong, Marion E van Hoorn, P Dick Bezemer, Alain D Mayhew
BACKGROUND: Placenta-mediated pregnancy complications include pre-eclampsia, late pregnancy loss, placental abruption, and birth of a small-for-gestational-age (SGA) neonate. These complications are leading causes of maternal, fetal, and neonatal morbidity and mortality in high-income countries. Affected women are at high risk of recurrence in subsequent pregnancies; however, effective strategies to prevent recurrence are absent. Findings from our previous study-level meta-analysis suggested that low-molecular-weight heparin reduced the risk of recurrent placenta-mediated pregnancy complications...
November 26, 2016: Lancet
https://www.readbyqxmd.com/read/27706532/optimal-anticoagulation-for-pregnant-women-with-mechanical-heart-valves
#12
Rohan D'Souza, Candice K Silversides, Claire McLintock
The prothrombotic state of pregnancy increases the risk of thromboembolic complications and death in women with mechanical heart valves (MHVs). Although it is accepted that these women must be on therapeutic anticoagulation throughout pregnancy, competing maternal and fetal risks, as well as the lack of high-quality data from prospective studies, make the choice of the optimal method of anticoagulation challenging. Vitamin K antagonists (VKAs) are associated with fewer maternal complications, but conversely also the lowest live birth rates as well as warfarin-related embryopathy and fetopathy...
October 5, 2016: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/27677928/birthweight-in-pregnant-women-with-protein-s-deficiency-treated-with-low-molecular-weight-heparin-a-retrospective-cohort-study
#13
Juan Jesús Fernández-Alba, Carmen González-Macías, Angel Vilar Sánchez, Pilar Tajada Cepero, Raquel Garrido Teruel, María José García-Cabanillas, Luis Javier Moreno-Corral, Rafael Torrejón Cardoso
OBJECTIVE: To determine the risk of small-for-gestational-age (SGA) and intrauterine growth retardation (IUGR) in pregnant women with protein S (PS) deficiency who received low-molecular-weight heparin (LMWH). METHODS: Retrospective cohort study of pregnant women seen from January 2002 to December 2011. The study cohort comprised a total of 328 patients with PS deficiency, who received prophylactic enoxaparin during pregnancy. The control cohort included 11 884 pregnant women without significant past medical history...
October 17, 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27640400/management-of-congenital-quantitative-fibrinogen-disorders-a-delphi-consensus
#14
A Casini, P de Moerloose
INTRODUCTION: No evidence-based guidelines for the management of patients suffering from afibrinogenaemia and hypofibrinogenaemia are available. AIM AND METHOD: The aim of this study was to harmonize patient's care among invited haemophilia experts from Belgium, France and Switzerland. A Delphi-like methodology was used to reach a consensus on: prophylaxis, bleeding, surgery, pregnancy and thrombosis management. RESULTS: The main final statements are as follows: (i) a secondary fibrinogen prophylaxis should be started after a first life-threatening bleeding in patients with afibrinogenaemia; (ii) during prophylaxis the target trough fibrinogen level should be 0...
November 2016: Haemophilia: the Official Journal of the World Federation of Hemophilia
https://www.readbyqxmd.com/read/27638899/management-of-inherited-thrombophilia-in-pregnancy
#15
Laura Ormesher, Louise Simcox, Clare Tower, Ian A Greer
Adverse pregnancy outcomes, such as pregnancy loss and pre-eclampsia, are associated with thrombotic mechanisms and thrombophilia. Antithrombotic interventions, particularly low-molecular-weight heparin, have been investigated in women identified by previous pregnancy outcome; however, the results have been inconsistent. This may reflect heterogeneity of both the study groups and the disease processes resulting in inadequate stratification to guide antithrombotic interventions. Furthermore, the variation in gestation at initiation of low-molecular-weight heparin treatment might be important...
July 2016: Women's Health
https://www.readbyqxmd.com/read/27599157/low-molecular-weight-heparin-and-aspirin-use-in-relation-to-pregnancy-outcome-in-women-with-systemic-lupus-erythematosus-and-antiphospholipid-syndrome-a-cohort-study
#16
Carolien N H Abheiden, Birgit S Blomjous, Sylvia J Kroese, Irene E M Bultink, Ruth D E Fritsch-Stork, A Titia Lely, Marjon A de Boer, Johanna I P de Vries
OBJECTIVE: To relate anticoagulant use to pregnancy complications in women with systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (APS). METHODS: All ongoing pregnancies, 184, in two Dutch tertiary centers between 2000 and 2015. RESULTS: LMWH and aspirin was prescribed in 15/109 SLE women without antiphospholipid antibodies (aPL), 5/14 with aPL, 11/13 with APS, 45/48 with primary APS. Main complications in the four treatment groups (no anticoagulant treatment, aspirin, LMWH, aspirin and LMWH) included hypertensive disorders of pregnancy (9...
September 6, 2016: Hypertension in Pregnancy
https://www.readbyqxmd.com/read/27598406/pregnancy-outcome-after-a-first-episode-of-cerebral-vein-thrombosis
#17
I Martinelli, S M Passamonti, A Maino, M Abbattista, P Bucciarelli, E Somigliana, A Artoni, F Gianniello, F Peyvandi
: Essentials Little is known about recurrences and pregnancy outcome after cerebral vein thrombosis (CVT). We studied a cohort of pregnant women with CVT. Women with CVT appear at increased risk of late obstetrical complications despite prophylaxis. Risks of recurrent thrombosis and bleeding in women on heparin prophylaxis while pregnant are low. SUMMARY: Background The risk of recurrent thrombosis and bleeding episodes in women with previous cerebral vein thrombosis (CVT) on antithrombotic prophylaxis with low-molecular-weight heparin (LMWH) during pregnancy is not established and little information is available on pregnancy outcome...
September 6, 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/27572887/low-molecular-weight-heparin-for-the-treatment-of-unexplained-recurrent-miscarriage-with-negative-antiphospholipid-antibodies-a-randomized-controlled-trial
#18
Omar M Shaaban, Ahmed M Abbas, Kamal M Zahran, Mohamed M Fathalla, Mohamed A Anan, Safwat A Salman
BACKGROUND: Recurrent miscarriage (RM) is one of the most common clinical problems in reproduction with no definite cause in about 50% of the cases. The study aims to evaluate the effect of low-molecular-weight heparin (LMWH) in the treatment of women with RM negatively tested for antiphospholipid antibodies (APAs). METHODS: An open-labeled registered randomized controlled study (NCT 01608347) included women who attended the outpatient clinic in Assiut Women Health Hospital and Nag-Hamady Central Hospital, Egypt, with 3 or more unexplained RM...
August 29, 2016: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/27566697/modulation-of-factors-involved-in-placental-haemostasis-and-angiogenesis-by-low-molecular-weight-heparins
#19
Elvira Grandone, Elena Chinni, Michela Villani, Natale Sciannamè, Giovanni L Tiscia, Giovanni Favuzzi, Filomena Cappucci, Francesco Petruzzelli, Maurizio Margaglione
PURPOSE: In placentae from uneventful pregnancies a direct relationship between expression of tissue factor (TF) and tissue-factor pathway inhibitor type 2 (TFPI2) was found, as well as between TF and vascular endothelial growth factor (VEGF). Furthermore, placentae from gestational vascular complications (GVCs) lack these correlations. Aims of the present study are (1) to evaluate a possible role of low-molecular-weight-heparins (LMWHs) in the modulation of the expression of TF, TFPI, TFPI2 and VEGF in placentae from thrombophilic women and (2) to study the possible role of endothelium in the placental expression of markers involved in haemostasis and angiogenesis...
August 26, 2016: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/27565128/management-of-direct-oral-anticoagulants-in-women-of-childbearing-potential-guidance-from-the-ssc-of-the-isth-comment
#20
M J R Desborough, S Pavord, B J Hunt
We welcome the recent guidelines from the Women's Health Issues SSC of the ISTH which provide much needed guidance on the management of direct oral anticoagulants (DOACs) in women of childbearing potential [1]. We agree with the guidance except for one area and feel there would be benefit in reconsidering one of the recommendations: "Should pregnancy be desired, we recommend that the DOAC is switched to an alternative anticoagulant preconceptually, with the main alternative anticoagulant options vitamin K antagonists (VKAs) (to be switched to low molecular weight heparin (LMWH) as soon as possible when pregnant and before 6 weeks of gestation), or LMWH, with cognizance that the latter may result in prolonged subcutaneous injections until pregnancy is achieved...
August 27, 2016: Journal of Thrombosis and Haemostasis: JTH
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