Use of fondaparinux for thromboprophylaxis in an unfractionated heparin‐intolerant pregnant woman with thrombotic predisposition

Abstract

A 34-year-old primigravida who had undergone thrombectomy for deep venous thrombosis (DVT) in her leg and exhibited low protein S activity, indicating predisposition to thrombosis, developed DVT of the leg. No pulmonary embolism was detected. After anticoagulant therapy with unfractionated heparin was discontinued because of liver dysfunction, danaparoid treatment was administered in hospital. The patient had a normal delivery after 39 weeks' gestation with no recurrence of thrombosis. During her second pregnancy four years later, she gave herself fondaparinux injections. She delivered normally after 38 weeks' gestation without experiencing DVT. Fondaparinux may be a useful anticoagulant for heparin-intolerant pregnant women.

Fondaparinux Pre-, Peri-, and/or Postpartum for the Prophylaxis/Treatment of Venous Thromboembolism (FondaPPP)

“…Typical reasons for changing from heparins to alternatives such as fondaparinux include allergic reactions at injection sites, generalized rashes, HIT, and increased liver enzymes related to heparin treatment. 9 , 14 , 17 , 33 - 35 Direct oral anticoagulants rivaroxaban and edoxaban are contraindicated during pregnancy. Apixaban and dabigatran have not been associated with embryotoxicity so far, but close surveillance is recommended in these patients; vitamin K antagonists should be avoided during pregnancy because they cross the placental barrier.…”