Low-molecular-weight heparin safe for pregnant women with prior VTE, study says

Written By : Medha Baranwal |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2022-05-27T19:30:57+05:30 | Updated On 19 Oct 2023 5:06 PM IST

Denmark: A new study supports the recommendation of low-molecular-weight heparin (LMWH) during pregnancy in women with prior venous thromboembolism (VTE) as the fetal risk was found to be lowest in unexposed and LMWH-exposed pregnancies. The safety of non-VKA oral anticoagulant (NOAC) during pregnancy was not clear owing to the rarity of NOAC exposure.

Mette Sogaard, Department of Cardiology, Aalborg University Hospital, Denmark, and colleagues aimed to determine first-trimester anticoagulant exposure and risks of adverse pregnancy-related and fetal outcomes in their study published in The American Journal of Medicine.

For this purpose, the researchers identified all pregnant women with preconception VTE using Danish nationwide registries and lined data on exposure to vitamin K antagonist (VKA), low-molecular-weight heparin, or non-VKA oral anticoagulant during pregnancy. Pregnancy-related and fetal outcomes associated with first-trimester anticoagulant exposure were then assessed.

The findings of the study were as follows:

· Among 4490 pregnancies in women with preconception venous thromboembolism (mean age 31 years, 40% nulliparous) during the first trimester, 63.1% were unexposed, and 25.9% were exposed to LMWH, 10.4% VKA, and 0.6% NOAC.

· Adverse outcomes were lowest in unexposed and LMWH exposed.

· Compared with unexposed, VKA was associated with higher risks of preterm (adjusted odds ratio [OR] 2.26) and very preterm birth (adjusted OR 3.78), shorter mean gestational age was associated with VKA (−7.5 days) or NOAC (−2.3 days), and lower mean birthweight with VKA (−55 g) or NOAC (−190 g).

· Adjusted ORs for small-for-gestational-age infants were 1.07 with VKA, and 3.29 with NOAC.

· Mean 5-minute Apgar score (9.8) and congenital defect prevalence (8.4%-10%) varied little across exposure groups.

To conclude, "fetal risk was lowest in unexposed and LMWH-exposed pregnancies, supporting the recommendation of LMWH during pregnancy. The safety of NOAC during pregnancy is not clear due to the rarity of NOAC exposure."

Reference:

Søgaard M, Skjøth F, Nielsen PB, Beyer-Westendorf J, Larsen TB. First Trimester Anticoagulant Exposure and Adverse Pregnancy Outcomes in Women with Preconception Venous Thromboembolism: A Nationwide Cohort Study. Am J Med. 2022 Apr;135(4):493-502.e5. doi: 10.1016/j.amjmed.2021.10.023. Epub 2021 Nov 17. PMID: 34798098.

American Journal of Medicinevenous thromboembolismpregnancyanticogulantslow molecular weight heparin

Source : American Journal of Medicine

Medha Baranwal

MSc. Biotechnology

Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751