Re: DVT and Pregnancy
From: Steve & Eryl Raymond (eryl@intekom.co.za)
Mon Feb 26 13:39:08 2001
"Griffiths Malcolm (RC9) Luton & Dunstable Hospital TR" wrote:
> None of these references seems more than consensus opinion. One of the
> authors (Ginsberg) is a reproductive endocrinologist!
>
> Yes and what's more this is for people who have a DVT in pregnancy, not for
> someone with a history of DVT in the past. Can't agree with prophylaxis
> throughout pregnancy for a DVT two years ago.
> -----Original Message-----
> From: eramirez@icepr.com [mailto:eramirez@icepr.com]
> Subject: Re: DVT and Pregnancy
>
> CLINICAL MANAGEMENT GUIDELINES FOR
> OBSTETRICIAN-GYNECOLOGISTS
> NUMBER 19, AUGUST 2000
>
> Thromboembolism in
> Pregnancy
> Unfractionated Heparin
> Low-dose prophylaxis:
> 1. 5,000-7,500 U every 12 hours during the first trimester
> 7,500-10,000 U every 12 hours during the second trimester
> 10,000 U every 12 hours during the third trimester
> unless the APTT* is elevated. The APTT may be
> checked near term and the heparin dose reduced if prolonged
> OR
> 2. 5,000-10,000 U every 12 hours throughout pregnancy
> Adjusted-dose prophylaxis:>,000 U twice a day to three times a day to
> achieve
> APTT of 1.5-2.5
>
> Low-Molecular-Weight Heparin
> Low-dose prophylaxis:
> Dalteparin, 5,000 U once or twice daily, or enoxaparin,
> 40 mg once or twice daily
>
> Adjusted-dose prophylaxis:
> Dalteparin, 5,000-10,000 U every 12 hours, or
> enoxaparin, 30-80 mg every 12 hours
>
> *APTT indicates activated partial thromboplastin time.
>
> Data from Colvin BT, Barrowcliffe TW. The British Society for
> Haematology guidelines on the use and monitoring of heparin 1992: second
> revision. J
> Clin Pathol 1993;46:97-103.
> Ginsberg JS, Hirsh J. Use of antithrombotic agents
> during pregnancy. Chest 1998;114: 524S-530S.
> Maternal and Neonatal Haemostasis Working Party of the Haemostasis and
> Thrombosis Task. Guidelines on the presentation, investigation and
> management of thrombosis associated with pregnancy. J Clin Pathol
> 1993;46:489-496
> At Fri, 23 Feb 2001, J. Hellriegel wrote:
> >
> >I agree with Efrain but have not increased dose of hparin until 3rd
> >trimester. Have also used 5,000 tid in third trimester.
> >
> >--
> >J. Hellriegel
> >
> >At Fri, 23 Feb 2001, Efrain Ramirez wrote:
> >>
> >>I don't agree with Malcom - prior DVT is an indication for prophylatic
> >>low dose heparin -I would give her heparin as you did - increase to
> >>8,000 BID at 20 weeks - no problem in labor - Lovenox is an alternative
> >>-- costly - give calcium with Vit D. Antiembolic stockings are Ok -
> >>
> >>At Fri, 23 Feb 2001, Griffiths Malcolm wrote:
> >>>
> >>>I don't think I or my colleagues would have had this patient on Heparin
> >>>through pregnancy. We would simply have dad her on low-dose heparin.
> >>>
> >>>However if you have decided to use it there are no real special
> precautions
> >>>at this dosage needed.
> >>>
> >>>If she has CS, I'd use anti-embolism stockings of pneumatic calf
> compression
> >>>(or both) as well.
> >>>
> >>>-----Original Message-----
> >>>From: Steven W Crawford [mailto:scrawfmd@zoomnet.net]
> >>>Sent: 22 February 2001 22:44
> >>>To: Multiple recipients of list OB-GYN-L
> >>>Subject: DVT and Pregnancy
> >>>
> >>>Dear List Members,
> >>>
> >>>I have a 22 yo G1 at 35 weeks gest, who has been on Heparin 5,000 units
> >>>SQ. BID since 18 weeks gestation.
> >>>
> >>>She is on Heparin due to her history of a left leg DVT a couple of years
> >>>ago.
> >>>
> >>>What should I do at time of delivery? Stop Heparin soon? Any
> >>>difference in management if she has a c-section versus a vaginal
> >>>delivery?
> >>>
> >>>Thank you very much for your help!
> >>>
> >>>Steven Crawford, MD
> >>>OB/GYN
> >>>Ohio
> >>
> >>--
> >>"Life is neither the notes nor the silence between the notes, but the
> music that
> >> arises out of sound and silence felt as a living whole. Stop
> choosing...between
> >> chaos and order, and live at the boundary between them, where rest and
> action
> >> move together..." David Whyte
> >>
> >--
> >John Hellriegel, MD, PhD
> >
>
> --
> "Life is neither the notes nor the silence between the notes, but the music
> that
> arises out of sound and silence felt as a living whole. Stop
> choosing...between
> chaos and order, and live at the boundary between them, where rest and
> action
> move together..." David Whyte
>
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--
Dr. S.H. Raymond
Department of Obstetrics & Gynaecology
Empangeni Hospital
Private Bag X20005
Empangeni
South Africa 3880
Ph. (+27) (035) 7721111
Fax (+27) (035) 7922596
