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PREGNANCY
THROMBOPROPHYLAXIS
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Agents for
Thromboprophylaxis
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Low molecular weight heparin
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BJOG. 2001
Nov;108(11):1134-40.
Venous thromboembolism during pregnancy: a retrospective study of enoxaparin
safety in 624 pregnancies.
Lepercq J, Conard J, Borel-Derlon A, Darmon JY, Boudignat O, Francoual C,
Priollet P, Cohen C, Yvelin N, Schved JF, Tournaire M, Borg JY.
Service de Gynecologie-Obstetrique, Hopital Saint Vincent-de-Paul, Paris,
France.
Objectives:
To assess the maternal, fetal and neonatal safety of enoxaparin
in pregnant women who require antithrombotic therapy.
Design:
Retrospective
analysis of case notes of women who received enoxaparin during pregnancy,
irrespective of dose, duration and reason for treatment.
Setting:
Fifty-five
French perinatal centres.
Sample:
Data from 624 pregnancies in 604 women
between 1988 and 1997. The incidence of previous thromboembolism was 29.8%,
known thrombophilia 15.2%.
Methods:
Indication, regimen of enoxaparin and
outcome measures were reported for each pregnancy. Information was obtained
from case records, validated by research staff and analysed by an
independent scientific committee.
Main Outcome Measures:
Incidence,
seriousness and causality of maternal, fetal and neonatal adverse events,
pregnancy outcome, and incidence of venous thromboembolism.
Results:
Enoxaparin was administered for treatment of an acute episode in 49 cases
and for thromboprophylaxis in 574 cases. Serious maternal haemorrhage
occurred in 11 cases during pregnancy (1.8%), one being reasonably related
to enoxaparin, and in nine cases at delivery (1.4%), all unrelated to
enoxaparin. Maternal thrombocytopenia was reported in 10 cases (1.6%). two
being serious but unrelated to enoxaparin. Eight pregnancies ended in
stillbirth (1.1%). Among the 693 live births, 17 major congenital
abnormalities (2.5%) and 10 serious neonatal haemorrhages (1.4%) were
reported. None of the fetal or neonatal adverse events was related to
enoxaparin. Eight venous thromboembolic events (1.3%) were reported.
Conclusions:
The incidence of adverse events reported could be explained by
the high risk profile of the study population. Overall, this retrospective
study suggests enoxaparin is well tolerated during pregnancy.
   
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