Bone density changes in pregnant women treated with heparin: a prospective, longitudinal study

Backos, M.; Rai, Raj; Thomas, Elizabeth; Murphy, Michael S.; Doré, Caroline J; Regan, Lesley

doi:10.1093/humrep/14.11.2876

Cited by 76 publications

(43 citation statements)

References 25 publications

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“…There were 15 studies (447 pregnancies) 27,29,30,37,42,43,60,62,66,79,80,87,88,93,97 in which the principal indication was prevention of RPL and 5 studies (88 pregnancies) 50,[69][70][71]96 in which LMWH was used to prevent preeclampsia, fetal growth restriction, or another adverse pregnancy outcome. The studies were heterogeneous with regard to whether coexistent thrombophilia was present.…”

Section: Lmwh For Prevention Of Adverse Pregnancy Outcomementioning

confidence: 99%

Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy

Greer

Nelson‐Piercy

2005

Blood

741

422

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To assess the safety and efficacy of lowmolecular-weight heparins (LMWHs) for thromboprophylaxis and treatment of venous thromboembolism (VTE) in pregnancy, a systematic review of studies to the end of 2003 was undertaken. Data on VTE recurrence and side effects were extracted and cumulative incidences of VTE and adverse effects calculated. Of 81 reports identified, 64 reporting 2777 pregnancies were included. In 15 studies (174 patients) the indication for LMWH was treatment of acute VTE, and in 61 studies (2603 pregnancies) it was thromboprophylaxis or adverse pregnancy outcome. There were no maternal deaths. VTE and arterial thrombosis (associated with antiphospholipid syndrome) were reported in 0.86% (95% confidence interval [CI], 0.55%-1.28%) and 0.50% (95% CI, 0.28%-0.84%) of pregnancies, respectively. Significant bleeding, generally associated with primary obstetric causes, occurred in 1.98% (95% CI, 1.50%-2.57%), allergic skin reactions in 1.80% (95% CI, 1.34%-2.37%), heparin-induced thrombocytopenia in 0%, thrombocytopenia (unrelated to LMWH) in 0.11% (95% CI, 0.02%-0.32%), and osteoporotic fracture in 0.04% (95% CI, < 0.01%-0.20%) of pregnancies. Overall, live births were reported in 94.7% of pregnancies, including 85.4% in those receiving LMWH for recurrent pregnancy loss. LMWH is both safe and effective to prevent or treat VTE in pregnancy. IntroductionPulmonary embolism (PE) remains the leading cause of direct maternal death in the United Kingdom 1 and venous thromboembolism (VTE) in pregnancy is an important cause of morbidity, not only in pregnancy but also in the long term. 2 Effective primary prevention and acute management of VTE in pregnancy are therefore important to reduce maternal mortality and morbidity. Coumarins cross the placenta and their use in pregnancy is associated with significant fetal and maternal risks, related particularly to teratogenesis and hemorrhage. 3 For many years, unfractionated heparin (UFH) was the standard anticoagulant used in pregnancy. 4 Low-molecular-weight heparins (LMWHs) have replaced UFH for the prevention and management of acute VTE without pregnancy. 5,6 In the United Kingdom, Europe, and Australasia, LMWHs are now also widely used for the prevention and treatment of VTE in pregnancy. 7,8 The advantages of LMWHs over UFH include an enhanced ratio of anti-Xa (antithrombotic) to anti-IIa (anticoagulant), resulting in a reduced risk of bleeding; stable and predictable pharmacokinetics with increased bioavailability and half-life, allowing less frequent fixed or weight-based dosing without the need for monitoring; subcutaneous administration 8 ; and less activation of platelets, with less binding to platelet factor 4 substantially reducing the risk of heparin-induced thrombocytopenia (HIT). 9,10 A major concern with the widespread use of UFH in pregnancy has been the 2% risk of symptomatic heparininduced osteoporotic fracture in pregnancy. 9 LMWHs are associated with a lower risk of this devastating complication. [11][12][13] Peer-reviewed international guid...

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Section: Lmwh For Prevention Of Adverse Pregnancy Outcomementioning

confidence: 99%

Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy

Greer

Nelson‐Piercy

2005

Blood

741

422

View full text Add to dashboard Cite

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“…25 Osteoporosis induced by long-term use of heparin has been reported. 26,27 Osteoblast inhibition may occur in vivo with unfractionated heparin. 28 Our patient had been prescribed unfractionated heparin during pregnancy, which may be a cause of osteoporosis.…”

Section: Figurementioning

confidence: 99%

Bilateral Subcapital Femoral Neck Fractures Secondary to Transient Osteoporosis during Pregnancy: A Case Report

Emami

Abdollahpour

Kazemi

et al. 2012

J Orthop Surg (Hong Kong)

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Transient osteoporosis during pregnancy is a rare, self-limiting disease. We report on a 36-year-old woman who had bilateral subcapital femoral neck fractures during the 6th month of pregnancy. The diagnosis was made 4 days after delivery, because radiography was declined by the patient for fear of radiation. Fixation was not feasible owing to bone resorption, and 2-stage bipolar hemiarthroplasty was therefore performed. Magnetic resonance imaging is the best non-invasive investigative tool for pregnant women with hip pain. Early detection can prevent complications and resorting to major surgeries.

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“…Probably LMWH have the same effect on bone in comparison to unfractionated heparin. 154,155 To limit bleeding risk, LMWH should be switched to unfractionated heparin at 36 th week of gestation and every treatment should be stopped when spontaneous labor begins or 24 h before planned induction of labor or Cesarean delivery, 149 except in the highest risk setting (recent pulmonary embolus). Heparin can be reintroduced from 6 to 12 h after vaginal delivery or from 12 to 24 h after Cesarean delivery and treatment should be continued for at least six weeks at a prophylactic dosage in case of high risk of thrombosis.…”

Section: -138mentioning

confidence: 99%

Pregnancy and heart disease: what Internists should know

Gerloni

Panuccio²

2017

Ital J Med

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Cardiac disease can rarely complicate pregnancy (e.g., only 1 to 4% of pregnancies in the United States), but it still remains a major cause of non-obstetric maternal morbidity and mortality. 1 During pregnancy, a woman can suffer from heart failure because of a pre-existing heart disease or a new onset cardiopathy pregnancy correlated. Approximately 2% of pregnancies involve cardiac disease, and in the current era, most maternal disease is due to congenital heart disease (CHD).2 Currently cardiac surgery improvement of the last 50 years has permitted an increased number of survivors. Instead, in the past, rheumatic heart disease was the leading cause of heart failure in pregnancy.3,4 Further, with increasing maternal age, other etiologies of heart disease should not be ignored and, particularly, ischemic and hypertensive heart disease should be considered in an over forty pregnant women. 5 Physiology of normal pregnancyImportant hemodynamic changes appear during pregnancy and are responsible for heart failure in pregnant women with pre-existing heart disease. These changes begin early in pregnancy, generally during the first eight weeks, reach their peak during the late second trimester, and then remain relatively constant until delivery. 6 The plasma volume and red cell mass are the first major cardiocirculatory modification, actually they expand in the 8 th week and peak around 30 th week, with a net plasma volume gain of 1000-1600 mL, corresponding to 30-50% above baseline.7 A greater increase in intravascular volume compared to red cell mass results in the dilutional anemia of pregnancy. This aspect generally results at 30-34 weeks when plasma volume peaks in relation to red cell mass and is associated with sodium and water retention. Actually 1000 mEq of sodium and 6 liters of water are retained and distributed among amniotic fluid, fetus and intra and extracellular spaces.8 Further cardiac output increases to satisfy increase fetal and maternal metabolic needs. It can be estimated 30-50% above baseline levels during the entire pregnancy, but half of this change occurs by 8 th week. This relevant change is a consequence of blood volume augmentation, afterload reduction and maternal heart rate rise.9 Systemic Pregnancy and heart disease: what Internists should know ABSTRACTPregnant women with heart disease are increasing due to medical and surgical progress and, nowadays, congenital heart disease is the most frequent heart disease affecting these women. Pregnancy represents a considerable effort for an altered heart with negative consequences for life quality, disease progression and mortality. Risk differs a lot among patients and depends not only on the type of heart disease. Clinician should stratify risk and offer patients a correct pre-counselling and accurate follow-up. At the same time Clinician should be able to diagnose rapidly heart failure as some cardiopathies, such as peripartum cardiomyopathy, are related to pregnancy and produce symptoms that can be confused with normal pregnancy progression...

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Bone density changes in pregnant women treated with heparin: a prospective, longitudinal study

Cited by 76 publications

References 25 publications

Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy

Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy

Bilateral Subcapital Femoral Neck Fractures Secondary to Transient Osteoporosis during Pregnancy: A Case Report

Pregnancy and heart disease: what Internists should know

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