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 anticoagulant effect at the time of delivery, which can complicate its use prior to labor. http://help-in-mens-health-problems.net/ add comment In a small level IV study, an anticoagulant effect persisted for up to 28 h after the last injection of adjusted-dose subcutaneous heparin, frequently resulting in deliveries that were complicated by a prolonged activated partial thromboplastin time (APTT). The mechanism for this prolonged effect is unclear. One way to avoid an unwanted anticoagulant effect during delivery in women receiving adjusted-dose subcutaneous heparin is to discontinue heparin 24 h prior to elective induction of labor. If spontaneous labor occurs in women receiving adjusted-dose subcutaneous heparin, careful monitoring of the APTT is required and, if it is prolonged near delivery, protamine sulfate may be required to reduce the risk of bleeding.
Long-term heparin therapy (>1 month) causes osteoporosis. Five recent studies provide estimates of the risk of heparin-induced osteoporosis with long-term administration of heparin. The results of these studies show that although the risk of symptomatic fractures is low (<2%), a subclinical reduction in bone density, detected radio-graphically, occurs in up to one third of women receiving long-term heparin therapy. The radiologic effects of heparin are at least partly reversible. It is unknown whether women with reduced bone density due to heparin are predisposed to future fractures. Although none of the five studies showed that the risk of osteoporosis is dependent upon the dosage of heparin used or the duration of heparin therapy, neither was any of them sufficiently large to exclude such relationships.
In some women, there can be considerable discomfort associated with twice-daily self-administered heparin injections. Therefore, the use of an indwelling subcutaneous teflon catheter, which must be replaced weekly, is a useful approach in pregnant women who require courses of long-term heparin