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Heparin vs. LuvanoxFrom: John Hellriegel (jhellrie@pce.net)Wed Sep 25 16:30:03 1996
Bill Kuyper <bkuyper@radiks.net> said: Any ideas/comments on the following: 27 y/o morbidly obese g1 at 14 weeks gestation. Discharged from hospital yesterday by internist and oncologist where she had been treated over the past 4 days for a "very bad" superficial thrombophlebitis. W/U excluded DVT but comments made that basically every superficial vein thrombosed. Patient at baseline has bad lower extremitiy varicosities. Pregnancy was not discovered until HD #3 (we won't comment on this fact as patient had multiple x-rays/CT's during this time). Pt was sent home on Luvonox 150 mgm BID, with the plan by the hematologist that she stay on this dose for the duration of the pregnancy. My questions are: 1. Is there enough experience with Luvanox in pregnancy to advocate it's use over Heparin? ANS: The papers I have seen on LMW heparin in pregnancy involve small numbers of patients, usually special situations, and are mostly not from the US. The FDA has not approved the use of Luvanox for pregnancy. I am not aware of any studies which demonstrate that LMW heparin is more effective or more cost effective than heparin for prophylaxis of DVT in pregnancy. Please see: Fejgin MD. Lourwood DL.’ Low molecular weight heparins and their use in obstetrics and gynecology. [Review], Obstetrical & Gynecological Survey. 49(6):424-31, 1994 Jun. I have a list of some 26 papers on this topic from Medline. Please e-mail me if you would like the list. 2. If this patient should be switched to Heparin is 7500 units BID adequate? Further, does a patient such as this really need to be fully anticoagulated during the pregnancy? ANS: I have not used prophylaxis for pregnant patients who have had superficial thrombophlebitis when not pregnant and have not used anticoagulation for postpartum superficial thrombophlebitis. I do not believe that a pregnant patient needs to be anticoagulated for superficial thrombophlebitis. That said, it might be prudent to use prophylaxis rather than risk the possible extension or progression of superficial thrombophlebitis to the deeps veins. I too am interested in the thoughts and comments of others on the list. -- John Hellriegel, Jr., MD, PhD Buffalo, NY jhellrie@pce.net
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