Challenging anticoagulation cases: A case of heparin-induced-thrombocytopenia in the first trimester of pregnancy

Diagnosis and management of heparin‐induced thrombocytopenia: Third edition

“…HIT is rare in pregnancy 37,125 with most cases occurring following exposure to UFH, 126 and only a few reported after LMWH. 84,126,127 Due to the low incidence, routine monitoring of the platelet count is not deemed necessary if treated exclusively with LMWH.…”

“…HIT is rare in pregnancy 37,125 with most cases occurring following exposure to UFH, 126 and only a few reported after LMWH. 84,126,127 Due to the low incidence, routine monitoring of the platelet count is not deemed necessary if treated exclusively with LMWH. 37 This is supported by a study of 31 pregnant women who received thromboprophylaxis with dalteparin for a median of 33 weeks (6-45 weeks) of whom none developed PF4-heparin antibodies.…”

“…129,130 Individualised written management plans are recommended for intrapartum and postpartum care as these drugs have variable half-lives, may be unfamiliar to the wider team, and confer a risk of intrapartum and postpartum haemorrhage. 126,130 A small number of case reports describe the successful use of argatroban, [131][132][133] although it needs to be administered intravenously and bridged to an alternative anti-thrombotic drug prior to discharge.…”

Heparin induced thrombocytopenia in pregnancy: A therapeutic challenge case report and literature review

“…anticoagulation, apixaban, argatroban, case report, heparin-induced thrombocytopenia, lupus anticoagulant, pregnancy complex heparin/platelet factor 4 (PF4) and then acting with Fcγ RIIa causes the activation of platelets and endothelial which result in manifestation of HIT. 1,2 Although the incidence of HIT in pregnancy is rare (1.72 per 1000), its diagnosis and treatment are vitally important due to the increased risk associated with thromboembolism. The neglected gradual decrease in the platelet count during hospitalization, which heralds HIT in a patient under anticoagulation therapy, may be assigned to a diagnostic challenge in pregnancy-related HIT.…”

“…HIT occurs in approximately 0.3%–3% of patients characterized by slightly low platelets counts and an increased tendency of thromboembolism events by over 50% of untreated patients. As the pathogenesis, the antibody formation against the complex heparin/platelet factor 4 (PF4) and then acting with Fcγ RIIa causes the activation of platelets and endothelial which result in manifestation of HIT 1,2 . Although the incidence of HIT in pregnancy is rare (1.72 per 1000), its diagnosis and treatment are vitally important due to the increased risk associated with thromboembolism.…”