Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Low-molecular-weight heparin in pregnancy: peripartum bleeding complications

Journal of Perinatology volume 27, pages 329–334 (2007)Cite this article

Abstract

Objective:

To compare bleeding complications in pregnant patients treated with low-molecular-weight heparin (LMWH) to untreated controls.

Study design:

A case–control study of patients from 2001 to 2005 who received prophylactic or therapeutic doses of LMWH during pregnancy was carried out. Indications for LMWH included current or prior thromboembolism, thrombophilia, or heart valve replacement. Controls were chosen in a 2:1 ratio to cases, matched for delivery route, and selected as the next two consecutive deliveries. The primary outcome was postpartum hemorrhage (PPH). Odds ratios (ORs) were calculated with 95% confidence intervals (CIs).

Results:

Forty-nine women treated with LMWH delivered 55 infants. Current or prior thromboembolic disease was the anticoagulation indication in 15/55 (27.3%) and 26/55 (47%) of pregnancies, respectively. There were more obese gravidas (OR 3.91, CI 1.70 to 9.09) and labor induction was more common in the LMWH group, 25/55 (45%) vs 29/110 (26%), P=0.01. There was no difference in estimated blood loss (295.7±145.7 vs 308.6±111.9 cm3, P=0.62 vaginal; 687.5±251.8 vs 765.0±313.2 cm3, P=0.34 cesarean), PPH (6/55, 11% vs 9/110, 8.2% OR 1.37, CI 0.16 to 11.5) or transfusion (3/55, 5.4% vs 4/110, 3.6% OR 1.50, CI 0.3 to 7.48) between the cases and controls. There were two cases of postpartum pulmonary emboli, one with a maternal mortality.

Conclusion:

Bleeding complications, including PPH and transfusion, in patients treated with LMWH during pregnancy were not increased when compared to normal controls matched for delivery route.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Hunt BJ, Doughty HA, Majumdar G, Copplestone A, Kerslake S, Buchanan N et al. Thromboprophylaxis with low molecular weight heparin (fragmin) in high risk pregnancies. Thromb Haemost 1997; 77: 39–43.

    Article  CAS  Google Scholar 

  2. Frydman A . Low-molecular-weight-heparins: an overview of their pharmacodynamics, pharmacokinetics and metabolism in humans. Haemostasis 1996; 26 (Suppl): 2:24–2:38.

    Google Scholar 

  3. Leizorovicz A, Simonneau G, Decousus H, Boissel JP . Comparison of efficacy and safety of low molecular weight heparins and unfractionated heparin in initial treatment of deep vein thrombosis: a meta-analysis. Br Med J 1994; 309: 299–304.

    Article  CAS  Google Scholar 

  4. Lensing AWA, Prins MH, Davidson BL, Hirsh J . Treatment of deep venous thrombosis with low molecular weight heparins: a meta-analysis. Arch Intern Med 1995; 155: 601–607.

    Article  CAS  Google Scholar 

  5. Siragusa S, Cosmi B, Piovella F, Hirsh J, Ginsberg JS . Low-molecular-weight heparins and unfractionated heparin in the treatment of patients with acute venous thromboembolism: results of a meta-analysis. Am J Med 1996; 100: 269–277.

    Article  CAS  Google Scholar 

  6. Dolovich L, Ginsberg JS . Low molecular weight heparin in the treatment of venous thromboembolism: an updated meta-analysis. Vessels 1997; 3: 4–11.

    Google Scholar 

  7. Gould MK, Dembitzer AD, Doyle RL, Hastie TJ, Garber AM . Low molecular weight heparins compared with unfractionated heparin for treatment of acute deep vein thrombosis: a meta-analysis of randomized, controlled trials. Ann Intern Med 1999; 130: 800–809.

    Article  CAS  Google Scholar 

  8. Pettila V, Leinonen P, Markkola A, Hiilesmaa V, Kaaja R . Postpartum bone mineral density in women treated for thromboprophylaxis with unfractionated heparin or LMW heparin. Thromb Haemost 2002; 87: 182–186.

    Article  CAS  Google Scholar 

  9. Warkentin TE, Levine MN, Hirsh J, Horsewood P, Roberts RS, Gent M et al. Heparin induced thrombocytopenia in patients treated with low molecular weight heparin or unfractionated heparin. N Eng J Med 1995; 332: 1330–1335.

    Article  CAS  Google Scholar 

  10. Laurent P, Dussarat GV, Bonal J, Jego C, Talard P, Bouchiat C et al. Low molecular weight heparins: a guide to their optimum use in pregnancy. Drugs 2002; 62: 463–477.

    Article  CAS  Google Scholar 

  11. Forestier F, Daffos F, Capella-Pavlovsky M . Low molecular weight heparin does not cross the placenta during the second trimester of pregnancy: study by direct fetal blood sampling under ultrasound. Thromb Res 1984; 34: 557–560.

    Article  CAS  Google Scholar 

  12. Forestier F, Daffos F, Rainaut M, Toulemonde F . Low molecular weight heparin (CY 216) does not cross the placenta during the third trimester of pregnancy. Thromb Haemost 1987; 57: 234.

    Article  CAS  Google Scholar 

  13. Safety of lovenox in pregnancy. ACOG committee opinion no. 276. American college of obstetricians and gynecologists. Obstet Gynecol 2002; 100: 845–846.

    Google Scholar 

  14. Sanson BJ, Lensing AW, Prins MH, Ginsberg JS, Barkagan ZS, Lavenne-Pardonge E et al. Safety of low-molecular-weight heparin in pregnancy: a systematic review. Thromb Haemost 1999; 5: 668–672.

    Article  Google Scholar 

  15. Ensom MH, Stephenson MD . Low-molecular-weight heparins in pregnancy. Pharmacotherapy 1999; 19: 1013–1025.

    Article  CAS  Google Scholar 

  16. Bates SM, Greer IA, Hirsh J, Ginsberg JS . Use of antithrombotic agents during pregnancy. Chest 2004; 126: 627S–644S.

    Article  CAS  Google Scholar 

  17. Horlocker TT, Wedel DJ . Neuraxial block and low-molecular-weight heparin: balancing perioperative analgesia and thromboprophylaxis. Reg Anesth Pain Med 1998; 23 (Suppl): 164–177.

    CAS  PubMed  Google Scholar 

  18. Horlocker TT, Wedel DJ . Spinal and epidural blockade and perioperative low molecular weight heparin: smooth sailing on the titanic. Anesth Analg 1998; 86: 1153–1156.

    CAS  Google Scholar 

  19. Checketts MR, Wildsmith JAW . Central nerve block and thromboprophylaxis – is there a problem? Br J Anaesth 1999; 82: 164–167.

    Article  CAS  Google Scholar 

  20. Jansen AJG, van Rhenen DJ, Steegers EAP, Duvekot JJ . Postpartum hemorrhage and transfusion of blood and blood components. Obstet Gynecol Surv 2005; 60: 663–671.

    Article  CAS  Google Scholar 

  21. Nelson-Piercy C, Letsky EA, deSwiet M . Low-molecular-weight heparin for obstetric thromboprophylaxis: experience of sixty-nine pregnancies in sixty-one women at high risk. Am J Obstet Gynecol 1997; 176: 1062–1068.

    Article  CAS  Google Scholar 

  22. Ellison J, Walker ID, Greer IA . Antenatal use of enoxaparin for prevention and treatment of thromboembolism in pregnancy. BJOG 2000; 107: 1116–1121.

    Article  CAS  Google Scholar 

  23. Lepercq J, Conard J, Borel-Derlon A, Darmon JY, Boudignat O, Francoual C et al. Venous thromboembolism during pregnancy: a retrospective study of enoxaparin safety in 624 pregnancies. BJOG 2001; 108: 1134–1140.

    CAS  Google Scholar 

  24. Rowan JA, McLintock C, Taylor RS, North RA . Prophylactic and therapeutic enoxaparin during pregnancy: indications, outcomes, and monitoring. Aust N Z J Obstet Gynecol 2003; 43: 123–128.

    Article  Google Scholar 

  25. Maslovitz S, Many A, Landsberg JA, Varon D, Lessing JB, Kupferminc MJ . The safety of low molecular weight heparin therapy during labor. J Matern Fetal Neonatl Med 2005; 17: 39–43.

    Article  CAS  Google Scholar 

  26. Thromboembolism in pregnancy. ACOG practice bulletin no. 19. American College of Obstetricians and Gynecologists. Obstet Gynecol 2000; 96.

  27. Brenner B, Bar J, Ellis M, Yarom I, Yohai D, Samueloff A, Live-Enox Investigators. Effects of enoxaparin on late pregnancy complications and neonatal outcome in women with recurrent pregnancy loss and thrombophilia: results from the Live-Enox study. Fertil Steril 2005; 84: 770–773.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

Poster presentation at the American College of Obstetricians and Gynecologists Annual Meeting in Washington DC, May 8, 2006.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, College of Medicine, University of Illinois Medical Center at Chicago, IL, USA

    M A Kominiarek, L Studee & J U Hibbard

  2. Department of Pharmacy Practice, College of Pharmacy, University of Illinois Medical Center at Chicago, IL, USA

    S M Angelopoulos, N L Shapiro & E A Nutescu

Authors
  1. M A Kominiarek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S M Angelopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N L Shapiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L Studee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E A Nutescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J U Hibbard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M A Kominiarek.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kominiarek, M., Angelopoulos, S., Shapiro, N. et al. Low-molecular-weight heparin in pregnancy: peripartum bleeding complications. J Perinatol 27, 329–334 (2007). https://doi.org/10.1038/sj.jp.7211745

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211745

Keywords

This article is cited by

Search

Advanced search

Quick links