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18 - Heparin-induced thrombocytopenia in pregnancy

Published online by Cambridge University Press:  01 February 2010

By
Barbara B. Haley M.D. ,
Rodger L. Bick M.D., Ph.D.  and
Eugene P. Frenkel M.D.
Edited by
Rodger L. Bick ,
Eugene P. Frenkel ,
William F. Baker  and
Ravi Sarode
Barbara B. Haley M.D.
Affiliation:
Professor of Medicine Sherry Wigley Crow Cancer Research Endowed Chair in Honour of Robert Lewis Kirby, M.D. University of Southwestern Medical School, Dallas, Texas, USA
Rodger L. Bick M.D., Ph.D.
Affiliation:
Clinical Professor of Medicine and Pathology, University of Taxas, Southwestern Medical Center
Eugene P. Frenkel M.D.
Affiliation:
Professor of Medicine and Radiology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas, Texas, SA
Rodger L. Bick
Affiliation:
University of Texas Southwestern Medical Center, Dallas
Eugene P. Frenkel
Affiliation:
University of Texas Southwestern Medical Center, Dallas
William F. Baker
Affiliation:
University of California, Los Angeles
Ravi Sarode
Affiliation:
University of Texas Southwestern Medical Center, Dallas
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Summary

Heparin is the most commonly used pharmacologic intervention to prevent or treat thrombosis in pregnancy. Both unfractionated heparin and low molecular weight heparins have been used successfully for therapeutic and prophylactic anticoagulation during gestation. Conversely, the use of coumadin in pregnancy is not advised as the drug crosses transplacentally and has been associated with a risk of fetal embryopathy and hemorrhage. The use of heparin, however, can have adverse clinical side effects for the pregnant female that include heparin-associated osteoporosis, eosinophilia, allergic reactions, ski rashes, and alopecia. However, the most significant and potentially devastating consequence is the development of heparin-induced thrombocytopenia. This is particularly true when the thrombocytopenia is paradoxically associated with either a venous or arterial thrombosis. Although heparin and low-molecular-weight (LMW) heparins are generally considered safe during pregnancy, a recent adverse reaction MedWatch report has been issued regarding the use of enoxaparin in pregnancy. This MedWatch report, issued January 9 2002 states the following: PRECAUTIONS:

Pregnancy

Teratogenic effects

There have been reports of congenital anomalies in infants born to women who received enoxaparin during pregnancy including cerebral anomalies, limb anomalies, hypospadias, peripheral vascular malformation, fibrotic dysplasia, and cardiac defect. A cause and effect relationship has not been established nor has the incidence been shown to be higher than in the general population.

Non-teratogenic effects

There have been post-marketing reports of fetal death when pregnant women received Lovenox Injection. Causality for these cases has not been determined. Pregnant women receiving anti-coagulants, including enoxaparin, are at increased risk for bleeding. Hemorrhage can occur at any site and may lead to death of mother and/or fetus. […]

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Chapter
Information
Hematological Complications in Obstetrics, Pregnancy, and Gynecology , pp. 556 - 569
Publisher: Cambridge University Press
Print publication year: 2006

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References

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  • Heparin-induced thrombocytopenia in pregnancy
    • By Barbara B. Haley, M.D., Professor of Medicine Sherry Wigley Crow Cancer Research Endowed Chair in Honour of Robert Lewis Kirby, M.D. University of Southwestern Medical School, Dallas, Texas, USA, Rodger L. Bick, M.D., Ph.D., Clinical Professor of Medicine and Pathology, University of Taxas, Southwestern Medical Center, Eugene P. Frenkel, M.D., Professor of Medicine and Radiology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas, Texas, SA
  • Edited by Rodger L. Bick, University of Texas Southwestern Medical Center, Dallas, Eugene P. Frenkel, University of Texas Southwestern Medical Center, Dallas, William F. Baker, University of California, Los Angeles, Ravi Sarode, University of Texas Southwestern Medical Center, Dallas
  • Book: Hematological Complications in Obstetrics, Pregnancy, and Gynecology
  • Online publication: 01 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511526978.019
Available formats
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Heparin-induced thrombocytopenia in pregnancy
    • By Barbara B. Haley, M.D., Professor of Medicine Sherry Wigley Crow Cancer Research Endowed Chair in Honour of Robert Lewis Kirby, M.D. University of Southwestern Medical School, Dallas, Texas, USA, Rodger L. Bick, M.D., Ph.D., Clinical Professor of Medicine and Pathology, University of Taxas, Southwestern Medical Center, Eugene P. Frenkel, M.D., Professor of Medicine and Radiology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas, Texas, SA
  • Edited by Rodger L. Bick, University of Texas Southwestern Medical Center, Dallas, Eugene P. Frenkel, University of Texas Southwestern Medical Center, Dallas, William F. Baker, University of California, Los Angeles, Ravi Sarode, University of Texas Southwestern Medical Center, Dallas
  • Book: Hematological Complications in Obstetrics, Pregnancy, and Gynecology
  • Online publication: 01 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511526978.019
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Heparin-induced thrombocytopenia in pregnancy
    • By Barbara B. Haley, M.D., Professor of Medicine Sherry Wigley Crow Cancer Research Endowed Chair in Honour of Robert Lewis Kirby, M.D. University of Southwestern Medical School, Dallas, Texas, USA, Rodger L. Bick, M.D., Ph.D., Clinical Professor of Medicine and Pathology, University of Taxas, Southwestern Medical Center, Eugene P. Frenkel, M.D., Professor of Medicine and Radiology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas, Texas, SA
  • Edited by Rodger L. Bick, University of Texas Southwestern Medical Center, Dallas, Eugene P. Frenkel, University of Texas Southwestern Medical Center, Dallas, William F. Baker, University of California, Los Angeles, Ravi Sarode, University of Texas Southwestern Medical Center, Dallas
  • Book: Hematological Complications in Obstetrics, Pregnancy, and Gynecology
  • Online publication: 01 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511526978.019
Available formats
×