Regular articlePharmacokinetic Profile of a Low-Molecular Weight Heparin (Reviparin) in Pregnant Patients: A Prospective Cohort Study*
Section snippets
Materials and Methods
The T.E.R.M. (Treatment and Evaluation for Recurrent Miscarriage) program is a multidisciplinary clinic for the evaluation and management of women with a history of recurrent fetal loss. As part of an ongoing evaluation of LMWH for the prevention of recurrent fetal loss at this clinic, consecutive patients with a history of unexplained fetal loss were asked to participate in a pilot study examining the use of LMWH in high-risk pregnancies. To be eligible for this evaluation, all patients had
Results
Reviparin was administered at a dose of 4900 units once daily to 42 patients and anti-Xa heparin levels were obtained between 6 and 37 weeks gestation (mean 20.6 weeks). Heparin levels were determined as soon as immediately after subcutaneous administration, or as late as 23 hours, 35 minutes after injection (mean, 9 hours and 14 minutes after injection; median, 8 hours after injection). No patients were lost to follow-up during the course of the investigation.
Anti-Xa heparin levels displayed a
Discussion
The anti-Xa heparin level achieved in pregnant patients receiving a fixed, once-daily subcutaneous dose of reviparin varied inversely with their weight. Thus, the initial degree of anticoagulation is dependent on the patient's baseline weight. The achieved degree of anticoagulation falls throughout pregnancy, as the patient's weight increases. This suggests that dose adjustment, to reflect changes in patient weight, will be required during pregnancy if the therapeutic goal is to maintain a
Acknowledgements
Dr Crowther holds a Research Scholarship from the Medical Research Council of Canada. Dr Ginsberg is a career investigator of the Heart and Stroke Foundation of Canada.
References (25)
- et al.
Anticoagulants in pregnancyFetal effects
Baillieres Clin Obs Gyn
(1997) Hazards of heparinAllergy, heparin-induced thrombocytopenia and osteoporosis
Baillieres Clin Obs Gyn
(1997)- et al.
Fragmin in unstable angina pectoris or in non-Q-wave acute myocardial infarction (the FRIC study). Fragmin in Unstable Coronary Artery Disease
Am J Cardiol
(1997) - et al.
The effects of low molecular weight and standard heparin on calcium loss from fetal rat calvaria
Blood
(1995) - et al.
Thromboembolic prophylaxis with low molecular weight heparin during pregnancy
Int J Gyn Obs
(1994) - et al.
Use of low molecular weight heparin for prophylaxis and treatment of thromboembolism in pregnancy
Int J Gyn Obs
(1992) - et al.
Lack of anti-factor Xa activity in umbilical cord vein samples after subcutaneous administration of heparin or low molecular mass heparin in pregnant women
Haemostasis
(1993) - et al.
Risks to the fetus of anticoagulant therapy during pregnancy
Thromb Haemostas
(1989) - et al.
The effects of long term heparin therapy during pregnancy on bone density. A matched cohort study
Thromb Haemostasis
(1996) - et al.
A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis
N Engl J Med
(1996)
Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The Tasman Study Group
N Engl J Med
Low-molecular weight heparin in the treatment of patients with venous thromboembolism
N Engl J Med
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The results of this paper were presented at the International Society of Thrombosis and Hemostasis Meeting in Washington D.C. in August of 1999.