Low molecular weight heparin (
LMWH) is widely regarded as the
anticoagulant treatment of choice for the prevention and treatment of
venous thromboembolism during pregnancy. However, previous studies have demonstrated that the pharmacokinetic profiles of
LMWH vary significantly with increasing gestation. Consequently, it remains unclear whether
LMWH regimens recommended for use in nonpregnant individuals can be safely extrapolated to pregnant women. The aims of this study were to assess the safety and the efficacy of
tinzaparin sodium (
Innohep) administered only once daily during pregnancy. A systematic retrospective review identified a cohort of 37 high-risk pregnancies which had been managed using
tinzaparin 175 IU/kg once daily. In 26 cases, the index pregnancy had been complicated by development of an acute
venous thromboembolism (17
deep vein thrombosis and nine
pulmonary embolism). For each individual, case notes were examined and data extracted using a predetermined questionnaire. No episodes of recurrent
venous thromboembolism were identified amongst this cohort of pregnancies managed using once daily
LMWH administration. However, two unusual thrombotic complications were observed, including a parietal
infarct in one patient, and a postpartum cerebral
venous thrombosis in another. Once daily
tinzaparin was well tolerated, with no cases of
heparin-induced thrombocytopaenia, symptomatic
osteoporosis, or foetal malformations.
Tinzaparin dose modification based upon peak anti-Xa levels occurred in 45% of the cases examined. The present study is the largest study to have examined the clinical efficacy of once daily
LMWH for use in pregnant women at high risk of
venous thromboembolism. Our data support the safety and efficacy of antenatal
tinzaparin at a dose of 175 IU/kg. In order to determine whether this once daily regimen provides equivalent (or indeed greater) thromboprophylaxis to twice daily
LMWH regimens during pregnancy will require highly powered direct comparative studies.