Review: LMWH safe, effective in pregnancy.(Obstetrics)

VIENNA -- The largest-ever systematic data review of the use of low-molecular-weight heparin during pregnancy suggests that it is safe and effective for both prophylaxis and treatment of venous thromboembolism, Catherine Nelson-Piercy, M.B., reported at the annual meeting of the International Society of Obstetric Medicine.

In recent years, low-molecular-weight heparin (LMWH) has become the standard therapy for both thromboprophylaxis and management of acute venous thromboembolism (VTE). "Thromboembolism is still the leading cause of maternal death in the U.K. For that reason, we are keen to promote the use of low-molecular-weight heparin for prophylaxis," said Dr. Nelson-Piercy, an obstetrician at Guy's and St. Thomas' Hospitals Trust, London.

There are still no large randomized trials to help guide practice in this area, however. To overcome this lack of data, Dr. Nelson-Piercy and her associate Ian Greer, M.D., of Glasgow (Scotland) University, conducted a systematic electronic database review of all studies through December 2003 that investigated the use of LMWH during pregnancy. Exclusion of studies of women with artificial heart valves, those that did not provide data on LMWH administration, and a few others for methodologic reasons left a total of 2,659 pregnancies from 59 separate reports.

Prophylaxis of VTE was by far the most common indication for LMWH use, comprising 28 studies and 1,319 pregnancies. Prevention of recurrent pregnancy loss, a rapidly growing use for LMWH, was the indication in 370 pregnancies in 14 studies, while treatment of VTE was the indication for 174 pregnancies in 15 studies.

Enoxaparin was the most common low-molecular-weight heparin used (1,158 pregnancies, including 105 for treatment and 1,048 for prophylaxis), followed by dalteparin (783) and nadroparin (530).

The reason for LMWH prophylaxis ...