Management of heparin allergy in pregnancy

Abstract

Thromboembolic disease during pregnancy has traditionally been treated with heparin. If heparin cannot be used, then treatment options remain limited. Despite the recent availability of new anticoagulation agents, data relating to their use during pregnancy is lacking. Hirudin, a relatively new anti-thrombotic agent, through animal models has been shown to have a very low transplacental transfer, thus making it a candidate drug to be used during pregnancy in case of heparin allergy. This report describes a case of heparin allergy in a pregnant patient with recurrent DVT that was successfully managed with hirudin and coumadin. Am. J. Hematol. 67:268-269, 2001.

Fondaparinux as anticoagulant in a pregnant woman with heparin allergy

“…Hirudin, a relatively new anti-thrombotic agent, has been shown through animal models to have a very low transplecental transfer and has been successfully used in a pregnant patient who was allergic to heparin, for recurrent deep vein thrombosis [7]. It has been reported, however that patients can develop anti-hirudin antibodies, which diminish its anticoagulant activity.…”

Treatment of heparin induced thrombocytopenia and thrombosis during the first trimester of pregnancy

“…Prophylactic treatment with subcutaneous lepirudin has been reported to be beneficial and safe during pregnancy in a patient with HIT without thrombosis [3]. Also, Aijaz et al described a case of HITT at 24 weeks gestation managed with a typical regimen of intravenous lepirudin followed by warfarin therapy [4]. Furthermore, lepirudin has been successfully used subcutaneously for the treatment of venous thromboembolism.…”

“…The frequency of DVT is well documented in surgical, gynecologic and intensive care unit patients [3][4][5], and prophylaxis has been shown to significantly reduced the risk of venous thromboembolism. Many medical conditions such as malignancy, neurological diseases with paresis, cardiac failure and acute myocardial infarction are associated with increased risk of thromboembolism, and prophylaxis had also been recommended [6].…”

“Heparin Allergy” Secondary to Preservative, Namely Benzyl Alcohol

“…Secondly, heparin has been combined with potent shortacting platelet agents to attenuate the immununologic reaction [6]. Alternatively, substitution to one of the low molecular weight heparins and/or synthetic pentasaccharide inhibitors has been successful [1,2,7]. However, delayed-type hypersensitivity to high and low molecular weight heparins does occur [4].…”

“…Heparin-induced IgE-mediated hypersensitivity and anaphylactoid reactions are rare but well-described entities [1][2][3]. Three distinct immune-mediated reactions have been described [1].…”