Reserve long-term heparin for high-risk patients. (Current Embolism, Deep Vein Thrombosis).

PALM BEACH, FLA. -- Obstetrical patients with thrombophilias are commonly given long-term heparin prophylaxis despite a lack of evidence that their abnormalities cause adverse outcomes, Dr. Baha Sibai said at the annual meeting of District V of the American College of Obstetricians and Gynecologists.

Long-term heparin therapy has been associated with subcutaneous bruising, hemorrhage, fracture, and occasionally, heparin-induced thromboembolism, placing many women at unnecessary risk. Discomfort from months of needle sticks and the high cost of low-molecular-weight heparin (LMWH) often used for this purpose are additional contraindications to such widespread use of heparin prophylaxis, said Dr. Sibai of the University of Cincinnati, an expert in preeclampsia.

His recommendation: Reserve long-term anticoagulation therapy for obstetrical patients at very high risk. In every other case, "we're treating our anxiety, not treating the patient," he said.

Under that criterion, previous thromboembolism during pregnancy or while taking oral contraceptives, factors typically recognized as indicating a need for heparin prophylaxis, would not warrant treatment. But a current embolism or deep vein thrombosis would.

Factor V Leiden mutation, found in 20% of obstetrical patients who develop thromboembolism, does require treatment, for example. The prevalence of this hereditary thrombophilia depends on the patient population: It is more common in whites than in African Americans, and it is almost never found in Asian or Hispanic ...