Osteopenia in pregnancy during long‐term heparin treatment: A radiological study post partum

Dahlman, Thomas C.; Lindvall, N; Hellgren, Margareta

doi:10.1111/j.1471-0528.1990.tb01785.x

Cited by 114 publications

(35 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…39 However, more recent analyses 35,56 support the drug's safety and efficacy. Osteopenia induced by heparin has been reported in pregnancy, 57,58 although it is usually associated with the administration of at least 20,000 IU per day for more than six months. 35 The osteopenia appears to be reversible in most cases.…”

Section: Complications Of Treatmentmentioning

confidence: 99%

Venous Thromboembolism during Pregnancy

1996

View full text Add to dashboard Cite

Section: Complications Of Treatmentmentioning

confidence: 99%

Venous Thromboembolism during Pregnancy

1996

View full text Add to dashboard Cite

“…However, recently an osteoporotic fracture of the lumbar spine in a young patient treated with low-dose LMWH for 3 months has been reported [308]. Heparin-induced osteoporosis is usually reversible after discontinuation of heparin therapy [302,311,325,326].…”

Section: Heparinmentioning

confidence: 98%

Drug-Induced Bone Loss

Tannirandorn

Epstein

2000

Osteoporosis International

View full text Add to dashboard Cite

Bone loss leading to osteoporosis is common after the menopause and in the elderly but uncommon in normal young adults without predisposing factors. The risk factors usually associated with osteoporosis include a family history of osteoporosis or fractures, aging, prior diseases, sedentary lifestyle, low calcium intake, hypogonadism, vitamin D deficiency, smoking, and excessive alcohol consumption. However, the issue of drugs has to be considered in 'normal' individuals who present with osteoporosis or bone loss without predisposing genetic or other environmental factors. The list of drugs is extensive and includes, amongst others, glucocorticoids, thyroid hormone (excess), alcohol, medroxyprogesterone acetate, luteinizing hormone-releasing hormone agonists, anti-seizure medications, cyclosporine A, aluminium, lithium, and exchange resins. This paper reviews the pathophysiology and mechanisms of drug-induced bone loss, which includes osteoporosis and osteomalacia, and treatment concepts. Undoubtedly, physician awareness, appropriate investigation, careful prescribing, monitoring, and proper therapy for this eminently preventable side effect can preserve bone in the patients receiving bone-losing drugs.

show abstract

“…It has been hoped that LMWHs will have fewer serious complications, including bleeding, 67-70 osteoporosis, [71][72][73][74][75][76][77][78] and HIT, 79,80 when compared with unfractionated heparin. Evidence is accumulating that these complications are indeed less serious and less frequent with the use of LMWHs.…”

Section: The Importance Of Initial Heparin Treatment On Long-term CLImentioning

confidence: 99%

Heparin and Low-Molecular-Weight Heparin Therapy for Venous Thromboembolism: Will Unfractionated Heparin Survive?

2004

Semin Thromb Hemost

View full text Add to dashboard Cite

Recent improvements in clinical trials methodology and the use of accurate objective tests to detect venous thromboembolism (VTE) have made it possible to carry out a series of randomized trials to evaluate various treatments for VTE. The results of these trials have resolved many of the uncertainties a clinician confronts in selecting the appropriate course of anticoagulant therapy. These trials have shown that the intensity of both initial heparin treatment and long-term anticoagulant therapy must be sufficient to prevent unacceptable rates of recurrence of VTE. Patients with proximal deep vein thrombosis who receive inadequate anticoagulant therapy have a risk of clinically evident, objectively documented recurrent VTE that approaches 20% to 25%. The need for adequate therapy with heparin and the importance of monitoring blood levels of the effect of heparin have been established. The importance of achieving adequate heparinization was suggested by a nonrandomized trial in 1972 and randomized trials in the 1980s have confirmed this finding. Furthermore, randomized trials have demonstrated the importance of achieving adequate heparinization early in the course of therapy. Unfractionated heparin by continuous intravenous infusion has provided an effective therapy for more than half a century, but the need to monitor therapy and establish therapeutic levels is a fundamental problem. It is evident that validated heparin protocols are more successful in establishing adequate heparinization than intuitive ordering by the clinician. However, even with the best of care using a heparin protocol, some patients treated with intravenous heparin will receive subtherapeutic treatment. In this context, subtherapeutic treatment reflects a practical limitation of the use of unfractionated heparin, rather than a poor standard of care. Furthermore, it is recognized that the practical difficulties associated with heparin administration are compounded by the substantive practical difficulties of standardizing activated partial thromboplastin time (aPTT) testing and the therapeutic range. Our findings have emphasized the confounding effect that initial heparin treatment has on long-term outcome. In all trials of long-term treatment, it is imperative that the initial therapy is of adequate intensity and duration; failure to administer adequate initial treatment may lead to a poor outcome that is falsely attributed to the long-term therapy under evaluation. Treatment with low-molecular-weight heparin (LMWH), which does not require monitoring or dose finding, has largely replaced unfractionated heparin for the initial management of VTE. Efficacy in terms of recurrent VTE or extension of thrombus has been at least as good with LMWH as unfractionated heparin and there is evidence that the incidence of major bleeding, heparin-induced thrombocytopenia, and osteoporosis are less with LMWH as compared with unfractionated heparin. Although unfractionated heparin may survive as a treatment option for acute VTE, its use has been largely suppla...

show abstract

Osteopenia in pregnancy during long‐term heparin treatment: A radiological study post partum

Cited by 114 publications

References 26 publications

Venous Thromboembolism during Pregnancy

Venous Thromboembolism during Pregnancy

Drug-Induced Bone Loss

Heparin and Low-Molecular-Weight Heparin Therapy for Venous Thromboembolism: Will Unfractionated Heparin Survive?

Contact Info

Product

Resources

About