Management and Outcome of Heparin-Induced Thrombocytopenia in Pregnancy: A Systematic Review
Systematic review published in Cardiovascular & hematological agents in medicinal chemistry (2015)
Abstract
OBJECTIVE: Safety and efficacy of therapeutic agents used for heparin-induced thrombocytopenia are not established in pregnancy. METHODS: MEDLINE database was searched in November 2014 to identify all patients who received therapy for HIT during pregnancy. RESULTS: A total of 12 patients with the median age of 28 years (range 21-39) were diagnosed with HIT at the median gestational age of 20 weeks (range 5-34). Clinical probability (4T) score for HIT was high (50%) or intermediate (50%) and associated with thrombosis in 50%. Patients were initially managed with lepirudin (33%), argatroban (25%), danaparoid (25%) or fondaparinux (17%) and ultimately bridged to vitamin K antagonist or maintained on lepirudin. All patients had resolution of HIT. Complications included therapeutic abortion prior to valve replacement for valve thrombosis (8%), preterm delivery (18%) and preeclampsia (8%). Except for one instance of hypoplastic lung related to preterm delivery, none of the other newborns had any complications during delivery. CONCLUSION: Confirmed cases of HIT in pregnant patients appear to be rare. Within the limits of retrospective analysis, the use of argatroban, danaparoid, fondaparinux and lepirudin may be effective in preventing the thrombotic complications of HIT in pregnancy. The effect of HIT or its therapy on obstetrical complications cannot be determined based on this study since many of the obstetrical complications are common in otherwise healthy pregnancies. Although this study did not identify any fetal teratogenicity except hypoplastic lung related to preterm delivery, small number of cases treated with various therapies precludes any definite conclusion.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Резюме
Management and Outcome of Heparin-Induced Thrombocytopenia in Pregnancy: A Systematic Review.
Почему это важно для гирудотерапии
This study searched MEDLINE to identify all reported patients who received therapy for heparin-induced thrombocytopenia (HIT) during pregnancy, finding 12 cases managed with lepirudin (33%), argatroban, danaparoid, or fondaparinux. All patients achieved resolution of HIT, though complications included preterm delivery, preeclampsia, and one therapeutic abortion. The abstract identifies lepirudin only by name without describing its origin or mechanism, and makes no mention of leeches, hirudin, or hirudotherapy, so a defensible connection to ASH's domain is not established by this article. Additionally, the extremely small number of identified cases treated with various therapies precludes any definite conclusion regarding safety or obstetrical outcomes.
Цитирование
Management and Outcome of Heparin-Induced Thrombocytopenia in Pregnancy: A Systematic Review
Chaudhary RK et al. · Cardiovascular & hematological agents in medicinal chemistry, 2015
Связанный клинический контекст
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