Heparin therapy during pregnancy; risks to the fetus and mother

Article Abstract:

Researchers reviewed the use of heparin, an anticoagulant, in pregnant women who required anticoagulant therapy. A study of 100 pregnancies in 77 different women was undertaken to evaluate the risk to the fetus and mother of heparin anticoagulant therapy for treatment of venous thromboembolic disease (VTE) related to valvular disease of the heart. Thromboembolisms are blood clots that are deposited in the circulatory system, causing obstructions of blood flow. Injections of heparin are thought to cause bleeding and osteoporosis in pregnant women. Heparin, unlike coumarin, another widely used anticoagulant, does not cross the membrane of the placenta and has not been associated with risks to the fetus. Previous research showed that heparin therapy was associated with unfavorable outcomes in about one third of pregnancies. Although the accuracy of this finding is in doubt, it has prompted a broader evaluation of the true risk to of heparin therapy to the mother and fetus. This study provides a more accurate estimate of the safety and efficiency of heparin therapy in the handling of thromboembolic disease. A maternal bleeding rate of 2.0 percent, consistent with findings in other studies, was reported. It is important to note that estimates derived from other research of the risk of recurrent VTE in women have ranged from five to 12 percent. Even a small risk of recurrent VTE may dictate the use of preventative heparin therapy in women with a history of VTE disease. All 71 of the patients who were directly interviewed were alive and free of symptoms associated with the adverse effects of heparin therapy for the treatment of VTE. Only two of the 77 patients who were administered heparin had prosthetic heart valves, so no conclusions can be drawn about the use of heparin in the prevention of systemic embolism in these patients. Finally, none of the patients experienced any bone fractures which would have been indicative of heparin-associated osteoporosis. Since sensitive bone density testing did not take place in this, subclinical reductions in bone density could not be ascertained. The results affirm the safety to both the fetus and mother of heparin use during pregnancy to prevent blood clots resulting from maternal valvular heart disease.

Risk factors, Fetus, Drug therapy, Anticoagulants (Medicine), Anticoagulants, Pregnancy, Thromboembolism

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Detection of previous proximal venous thrombosis with Doppler ultrasonography and photoplethysmography

Article Abstract:

Deep venous thrombosis (DVT), the formation of a clot in the deep veins, is a difficult condition to accurately confirm. Contrast venography, a contrast-enhanced X-ray image of the blood vessels, has been the most widely-used technique for diagnosing DVT. This technique is invasive and has not achieved a high degree of accuracy. In light of those deficiencies, researchers evaluated Doppler ultrasonography (Doppler US) and photoplethysomography (PPG) for the detection of DVT. A plethysmograph is a device capable of measuring variations in the size of a body part as a result of variations in the amount of blood passing through or contained in it; Doppler US uses reflected sound waves to measure various aspects of blood flow. Both Doppler US and PPG are noninvasive diagnostic procedures. In order to better diagnose cases of proximal DVT, i.e. occurring close to the point where the vein drains into the inferior vena cava (the body's largest vein which returns blood to the right side of the heart), researchers evaluated the combined use of venous US and PPG. These techniques were used to detect abnormalities of the venous valves in a group of 82 patients, 33 of whom were confirmed as having DVT (DVT+) and 49 of whom were confirmed as not having DVT (DVT- status). Twenty-nine of the DVT+ patients had abnormal PPG and/or Doppler US results, while 10 of the 49 DVT- patients had abnormal PPG and/or Doppler US findings. PPG and Doppler US measurements may be abnormal in situations of superficial venous reflux, a backflow which occurs with varicose veins. Patients with moderate to severe varicose veins may be misdiagnosed by PPG as DVT+, and therefore PPG is unreliable in the prediction of previous proximal DVT in such patients. After combining results for a number of DVT conditions, the results demonstrated that DVT can be confirmed or refuted in about 80 percent of patients with known prior incidents of suspected DVT through the use of combined PPG/Doppler US diagnosis. A normal PPG and Doppler US finding will exclude previous proximal DVT with a high degree of accuracy.

Diagnosis, Plethysmography, Thrombosis, Doppler ultrasonography, Veins

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Low-dose heparin: a cause of hematoma of rectus abdominis

Article Abstract:

Patients who need to remain immobile for long periods of time are often given injections of the anticoagulant heparin to prevent the development of blood clots. Heparin is usually injected subcutaneously (under the skin) in the abdominal region, and has been associated with few complications. However, there have been reports of hematoma of the rectus abdominis muscle, one of the major abdominal muscles, following heparin injection. (A hematoma is a localized collection of clotted blood in an organ or tissue.) A 63-year-old woman in respiratory failure was put on a respirator and given 5,000 Units of subcutaneous heparin in the abdomen every 8 hours. After being extubated (removed from the respirator), she complained of abdominal pain, and small hematomas were noted near the injection sites. An abdominal ultrasound indicated a large mass, and a CT scan revealed a hematoma of the rectus abdominis muscle. The hematoma extended from the pelvis to the umbilicus (belly button). Heparin was discontinued, and the hematoma gradually resolved. There have been three other cases of hematoma of the rectus abdominis due to subcutaneous heparin injections; this complication led to the deaths of two patients. All three patients had experienced severe coughing due to respiratory disease, and this may have caused tears in the muscle and contributed to the development of hematoma. The authors advise that, in patients with cough due to respiratory disease, heparin should be injected subcutaneously into the thigh, and the injections should be given less frequently. Using the proper technique when injecting the drug may also help to prevent this complication. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Hematoma, Dosage and administration, Injections, Hypodermic, Subcutaneous injections, Abdomen, Abdominal muscles

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