Fondaparinux as anticoagulant in a pregnant woman with heparin allergy

Abstract

We report a patient who had a history of deep vein thrombosis in a previous pregnancy. She was treated with heparins without any reactions in the index pregnancy. Subsequently, when the patient became pregnant again, she developed an acute cutaneous reaction to the low molecular heparin enoxaparin 3 weeks after initiation of therapy. She developed a similar reaction to delteparin as well. She was therefore treated with warfarin until 36 weeks of gestation. Then she was treated with fondaparinux (Arixtra, Sanofi-Synthelabo, Paris, France) 2.5 mg daily for the remainder of the pregnancy. Delivery was at term by induction of labour. Fondaparinux was stopped on the day of the induction of labour. It was re-started 6 h post-delivery and the patient was anticoagulated with warfarin in the post-partum period. There were no bleeding tendencies or recurrences of thrombosis during fondaparinux therapy. Both mother and baby were well after delivery.

VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy

“…69 Although there have been a small number of reports of the successful use of this agent in pregnant woman, [70][71][72][73][74][75][76] most of these involve second trimester or later exposure. Thus, the quality of evidence regarding supporting use of fondaparinux in pregnancy is very low.…”

Cardiovascular Management in Pregnancy

“…Fondaparinux is an indirect factor Xa inhibitor with the largest collection of case-based data in pregnancy. [48][49][50][51][52][53][54] Two direct factor Xa inhibitors, argatroban and lepirudin, have published human data in pregnancy. [55][56][57] Fondaparinux is recommended by the American College of Obstetrics and Gynecology for anticoagulation in the setting of heparin-induced thrombocytopenia or other heparin allergy.…”

Fondaparinux as an alternative anticoagulant therapy during pregnancy

“…Although it has been shown that transplacental passage can occur resulting in low measurable FXa activity in cord blood [11], no adverse outcomes in pregnancy have been reported in these four women. The other six separately published cases reported no adverse events to the mother or child [6][7][8][9][10]. In our hospital, experience with fondaparinux as an alternative in pregnant women has accumulated.…”

“…Fondaparinux has been extensively studied for use in surgery prophylaxis and treatment of thromboembolic diseases [5]. However, data on the use of fondaparinux in pregnancy is limited to animal models and a few case reports [6][7][8][9][10]. Although it has been shown that transplacental passage can occur resulting in low measurable FXa activity in cord blood [11], no adverse outcomes in pregnancy have been reported in these four women.…”

“…Recent analyzes have explored the implications of such incidental events and it has been questioned whether these are truly asymptomatic events [8]. Additionally, in a recent retrospective analysis, 6-month mortality was similar in cancer patients with symptomatic or asymptomatic VTE but significantly higher in comparison to cancer patients without VTE [9]. These analyzes have focused primarily on incidental events.…”