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Low molecular weight heparin in pregnancyFrom: Kenneth Moise, MD (kmoise@bcm.tmc.edu)Sat Aug 30 12:22:53 1997
I would concur that the use of low molecular weight heparin is at best experimental. Advantages: 1) One injection per day 2) Proven decreased incidence of thrombocytopenia in non-pregnant patients (I have never seen this is a pregnant patient on standard heparin, although the risk is reported at 5%). 3) Potential: less risk for osteoporosis (this is unproven in human trials). Disadvantages: 1) COST, COST, COST. A daily injection of 40 mg subcut runs $1,400/month at our pharmacies here in Houston; standard unfractionated heparin (8 - 10,000 U subcut Q 8 hrs) runs $30/month. Try running that past your HMO. 2) No way to know the dose in pregnancy - is 40mg Q day enough? In one of the most recent articles to which you were referring in your post, the authors increased the dose from 30 mg to 40 mg/day after one pregnant patient developed a DVT. 3) What medicolegal risks would be incurred if a pregnant patient develops a DVT on this therapy? Would there be experts willing to testify that this is not accepted therapy. Remember the FDA has only approved low molecular weight heparin for prophylaxis after orthopedic and abdominal surgery, not for the treatment of DVT. 4) If one tries to monitor therapy, one needs to obtain heparin levels - usually performed at a reference lab. PTT's are readily available at most laboratories and can be used to easily monitor standard (unfractionated) heparin therapy. My 2 cents - I would not use it at present. Ken Moise Baylor College of Medicine
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