Key result
Pregnant women with severe antithrombin deficiency required high doses of low molecular weight heparin (average 20,220 IU/day) to achieve therapeutic anti-activated factor X levels.
Why the study?
What dose of low molecular weight heparin is required to achieve therapeutic anti-activated factor X levels in pregnant women with severe antithrombin deficiency?
Observational (n=18)
Yes
What dose of low molecular weight heparin is required to achieve therapeutic anti-activated factor X levels in pregnant women with severe antithrombin deficiency?
Pregnant women with severe antithrombin deficiency require unusually high doses of low molecular weight heparin (average 20,220 IU/day) to achieve therapeutic anticoagulation.
May inform LMWH dosing in antithrombin-deficient pregnancies; leaves open need for prospective outcome trials before practice change.
Antithrombin deficiency is identified as one of the most potent risk factors for venous thromboembolism during pregnancy. Therapeutic low molecular weight heparin is recommended, but it can be difficult to attain sufficient anticoagulation since low molecular weight heparin requires antithrombin to exert its anticoagulant effect. We carried out a multicentre case-series assessing the dose of low molecular weight heparin required to achieve therapeutic anti-activated factor X levels in pregnant women with antithrombin deficiency. We assessed 27 pregnancies in 18 women with severe antithrombin deficiency, which we defined as an antithrombin level of <0.55 IU/ml (with or without prior venous thromboembolism) or an antithrombin level < 0.8 IU/ml and a personal history of venous thromboembolism. Our data illustrate the need for high doses of low molecular weight heparin to achieve therapeutic anti-activated factor X levels (average 20,220 IU/day). All pregnancies ended in live birth (excluding one elective termination), although intrauterine growth restriction occurred in five (18%).
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Pearson‐Stuttard et al. (2018) conducted an observational in Severe antithrombin deficiency in pregnancy (n=18). Low molecular weight heparin was evaluated on Dose of low molecular weight heparin required to achieve therapeutic anti-activated factor X levels. Pregnant women with severe antithrombin deficiency required high doses of low molecular weight heparin (average 20,220 IU/day) to achieve therapeutic anti-activated factor X levels.
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