ALTERNATIVE ANTICOAGULATION WITH DANAPAROID IN TWO PREGNANCIES IN A PATIENT WITH FORMER HIT, THROMBOPHILIA, A HISTORY OF VENOUS THROMBOSIS AND RECURRENT PREGNANCY LOSSES
Abstract number: P-W-589
Schindewolf1 M., Linnemann1 B., Klaeffling1 C., Lindhoff-Last1 E.
1Internal Medicine, Division of Vascular Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
How-to-cite Schindewolf M, Linnemann B, Klaeffling C, Lindhoff-Last E. ALTERNATIVE ANTICOAGULATION WITH DANAPAROID IN TWO PREGNANCIES IN A PATIENT WITH FORMER HIT, THROMBOPHILIA, A HISTORY OF VENOUS THROMBOSIS AND RECURRENT PREGNANCY LOSSES. J Thromb Haemost 2007; 5 Supplement 2: P-W-589
Introduction: We report on the successful management of 2 pregnancies of a 33 year-old caucasian female with an amputation of her left calf due to phlegmasia coerulea dolens in consequence of a HIT II which occurred during heparin therapy because of spontaneous pelvic vein thrombosis. Furthermore, she yielded a homozygous fVL-mutation.
Methods: HIT was diagnosed by heparin-PF4-antibody-ELISA and heparin-induced platelet aggregation assay (HIPA). Cross-reactivity with danaparoid was ruled out in the HIPA. The Danaparoid concentration was measured with a chromogenic anti-Xa assay.
Results: In 10/01 the patient appeared in our department for advice in an intended pregnancy.
We recommended a switch of long-term anticoagulation with phenprocoumon to coumadin with pregnancy tests every 2nd week. After confirmed pregnancy we changed to danaparoid 2x1500 U/die under strict control of anti-Xa levels (0,4-0,6 aXa-U/ml). Throughout 2002 she sustained 3 spontaneous abortions (8th week of pregnancy (WOP) each). Gynecologic and endocrinologic testings were negative. Genetic analysis revealed a balanced translocation of chromosome 1/9 as probable cause. In 01/04 and 11/05 she appeared in her 22nd and 18th WOP, respectivley, under the recommended regimen (danaparoid 2x1500 aXa-U/die). In the 2nd pregnancy a marginal subtherapeutic anti-Xa-level was tolerated due to local bleedings at injection sites after transient dose increasement to 1 x 2250 and 1 x 1500 U/die after her 33rd WOP. Danaparoid was maintained until 24h before spontaneous delivery, restarted 12h and 4h, respectively, thereafter and maintained in the 6 weeks period of childbed. No bleeding or thromboembolic complications occurred during and after delivery of a healthy infant each.
Conclusions: This case shows the management of two pregnancies in a patient with HIT, homozygous fVL-mutation and recurrent pregnancy losses successfully treated with danaparoid which proves once more to be the alternative anticoagulant of choice in pregnant patients with former HIT.
To cite this abstract use the following format:
Journal of Thrombosis and Haemostasis 2007; Volume 5, Supplement 2: abstract number
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