Archive for the 'Antithrombotic Agents' Category

02 Aug

Use of Antithrombotic Agents During Pregnancy: Conclusion

Prophylaxis in Patients With Mechanical Heart Valves The management of pregnant patients with mechanical heart valves is problematic because the efficacy of heparin is not established. Nevertheless, it is likely that full doses of heparin are effective in preventing systemic embolism. Two approaches have been recommended (both are grade C2): the first is to use […]

31 Jul

Use of Antithrombotic Agents During Pregnancy: Recommendations

Previous Venous Thromboembolism (Prophylaxis) In pregnant women with a history of previous venous thromboembolic disease, the true risk of recurrence in untreated patients is unknown and estimates range from 0 to 15%.~ Consequently, some form of prophylaxis or surveillance should be considered. Our approach is to use clinical surveillance antepartum (widr postpartum warfarin) in women […]

29 Jul

Use of Antithrombotic Agents During Pregnancy: Summary and Conclusions

Anticoagulant therapy is indicated during pregnancy for the prevention and treatment of VTE, for the prevention and treatment of systemic embolism in patients with mechanical heart valves, and, in combination with aspirin, for the prevention of pregnancy loss in women with APLA and previous pregnancy losses. Several questions concerning anticoagulant therapy remain unanswered. Oral anticoagulants […]

27 Jul

Use of Antithrombotic Agents During Pregnancy: Antiphospholipid Antibodies

The management of these patients is problematic because few large clinical trials evaluating therapy have been performed. Regimens that have been evaluated include aspirin alone or in combination with prednisone or unfractionated heparin, and IV 7-globulin. A relatively large placebo-controlled, randomized, level I trial has recently been published and shows no benefit to the use […]

25 Jul

Use of Antithrombotic Agents During Pregnancy: Warfarin

Warfarin should be avoided between 6 and 12 weeks of gestation (to avoid embryopathy) and close to term (to avoid delivery of an anticoagulated fetus) but is probably safe. We believe it is reasonable to use subcutaneous heparin either during these periods only, with warfarin and a target international normalized ratio (INR) of 3.0 (range […]

23 Jul

Use of Antithrombotic Agents During Pregnancy: Management of Pregnant Women With Prosthetic Heart Valves

Although the reported high rates of thromboembolism might be explained by inadequate heparin dosing and/or the use of an inappropriate target therapeutic range, this recent publication does raise the concern that patients with mechanical heart valves are resistant to moderate doses of heparin and draws attention to the need to use adequate heparin doses in […]

21 Jul

Use of Antithrombotic Agents During Pregnancy: Dose of heparin

However, there is a concern that a dose of heparin 5,000 U subcutaneously ql2h may be insufficient in high-risk situations because it does not reliably produce detectable heparin levels. There is also published level III data that more intense heparin therapy, in doses that produce plasma heparin levels (measured as anti-factor Xa activity) of 0.1 […]

19 Jul

Use of Antithrombotic Agents During Pregnancy: Efficacy of Anticoagulants for the Prevention and Treatment of VTE During Pregnancy

There is a paucity of data about the efficacy of anticoagulants for the prevention and treatment of VTE during pregnancy. Accordingly, the recommendations about their use during pregnancy is based largely upon extrapolations from data from nonpregnant patients, from case reports, and from case series of pregnant patients. Based upon the safety data, heparin is […]

17 Jul

Use of Antithrombotic Agents During Pregnancy: Use of Anticoagulants in the Nursing Mother

Heparin is not secreted in breast milk and can be administered safely to nursing mothers. There have been two convincing reports that warfarin does not induce an anticoagulant effect in the breast-fed infant when the drug is administered to a nursing mother Therefore, the use of warfarin in women who require postpartum anticoagulant therapy is […]

15 Jul

Use of Antithrombotic Agents During Pregnancy: Maternal Complications of Anticoagulant Therapy During Pregnancy

In a level IV cohort study, the rate of major bleeding in pregnant patients treated with heparin was 2%, which is consistent with the reported rates of bleeding associated with heparin therapy in nonpregnant patients and with warfarin therapy when used for the treatment of DVT. In addition, adjusted-dose subcutaneous heparin can cause a persistent […]

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