Minimising the risk of heparin-induced osteoporosis during pregnancy

  title={Minimising the risk of heparin-induced osteoporosis during pregnancy},
  author={David Hawkins and Jeffrey J. Evans},
  journal={Expert Opinion on Drug Safety},
  pages={583 - 590}
Unfractionated heparin (UFH) may lead to symptomatic vertebral fractures in up to 3 out of every 100 people on long-term therapy. Ten-times that many people will experience a significant reduction in bone density leading to osteopoenia or osteoporosis. Low molecular weight heparins (LMWH) have been shown to be as effective as UFH in the prevention and treatment of venous thromboembolism. Several well-established advantages of LMWH over UFH include increased bioavailability, more predictable… 

Fondaparinux for the prevention or treatment of venous thromboembolism related to lower limb trauma: evidence today.

The clinical studies evaluating the safety, efficacy, and financial implications associated with lower limb orthopaedic trauma show that fondaparinux has comparable results with the well-established use of enoxaparin, however, the scientific community has raised several issues regarding mostly fondAParinux's safety, timing of its 1(st) dose, bleeding side effects, duration of administration and lack of a reliable reversing agent.

Anticoagulation via anti-Factor Xa inhibition

Fondaparinux, the first of a new class of agents Factor Xa inhibitiors, has recently come into clinical use and has a favourable side effect profile and if the price is acceptable, is likely to take over from low molecular weight heparins in these indications as the drug of choice on the grounds of efficacy and safety.

Conventional Anticoagulant Therapy

Conventional antithrombotic therapy is the mainstay of anticoagulant therapy that have been used for over 40 years in the treatment of thrombosis and it includes unfractionated heparin, low-molecular-weight heparins  (LMWHs) and vitamin K antagonists.

Management of Anticoagulation in Pregnant Women With Mechanical Heart Valves

Data suggest that the use of low-molecular-weight heparin with appropriate dosing and monitoring for the anticoagulation of pregnant women with MHVs suggests that this approach minimizes the thrombotic risk associated with the valve while also providing safe and effective antICOagulation that can be easily managed in the peripartum period.

Heparin induces mobilization of osteoprotegerin into the circulation.

It is concluded that UFH causes a more pronounced vascular mobilization of OPG than LMWH, indicating that UFS has a higher affinity for OPG compared to LMWH.

Adverse effects of heparin.

  • S. Alban
  • Medicine, Biology
    Handbook of experimental pharmacology
  • 2012
Frequent and therefore important adverse reactions of heparins are skin lesions resulting from delayed-type hypersensitivity reactions, and all the other undesirable effects are discussed as well, but they are mostly clinically irrelevant.

A longitudinal study of the effect of heparin thromboprophylaxis during pregnancy on maternal bone metabolism

During pregnancy, the rate of change of PicP and ICTP in women who had heparin thromboprophylaxis was similar to those of women who did not, and PICP andICTP levels at individual time points were similar in both groups.

Safety of Therapeutic Doses of Tinzaparin During Pregnancy

The safety of once-daily therapeutic doses of tinzaparin at therapeutic dose for the treatment of venous thromboembolism (VTE) during pregnancy is supported.

Expert Review: Prevention of Obstetric Venous Thromboembolism.

Anticoagulants and pregnancy: When are they safe?

Low-molecular-weight heparins and unfractionated heparin are effective and safe, with caveats, and further research should help to clarify who should receive thromboprophylaxis, how to prevent adverse pregnancy outcomes in women with various thrombs, and how best to treat pregnant women who have a prosthetic heart valve.



Changes in Bone Density during Long-Term Administration of Low-Molecular-Weight Heparins or Acenocoumarol for Secondary Prophylaxis of Venous Thromboembolism

It might be advisable to perform densitometry before starting long-term anticoagulation and to repeat it every 12 months, especially in patients with concomitant risk factors for osteoporosis in order to identify patients in need of its prophylaxis.

Postpartum bone mineral density in women treated for thromboprophylaxis with unfractionated heparin or LMW heparin.

Dalteparin is recommended instead of UF heparin for long-term thromboprophylaxis during and after pregnancy and puerperium for pregnant women with confirmed previous or current thromboembolism.

Comparison of subcutaneous unfractionated heparin with a low molecular weight heparin (Fragmin) in patients with venous thromboembolism and contraindications to coumarin.

This study aimed to compare the efficacy and safety of unfractionated (UF) heparin with that of a low molecular weight Heparin (Fragmin, Kabi Pharmacia) in the prevention of recurrent deep venous thrombosis (DVT) and pulmonary embolism (PE) in a consecutive series of patients with contraindications to coumarin therapy.

Dosing and Monitoring of Low‐Molecular‐Weight Heparins in Special Populations

Routine monitoring of anti‐Xa activity in clinically stable adults with uncomplicated disease is not recommended, but the optimal dosage of LMWHs has not been established for patients with renal insufficiency or extremes of body weight, during pregnancy, or for children, anti‐ Xa activity monitoring may be warranted in these subsets.

Low molecular weight heparins: a guide to their optimum use in pregnancy.

In prophylaxis settings, dalteparin sodium and enoxaparin sodium have been the most widely studied LMWH and it is believed that priority should be given to those products.

Use of antithrombotic agents during pregnancy.

Oral anticoagulant therapy should be avoided in the weeks before delivery because of the risk of serious perinatal bleeding caused by the trauma of delivery to the antICOagulated fetus, and the safety of aspirin during the first trimester of pregnancy is still a subject of debate.

Treatment of 51 pregnancies with danaparoid because of heparin intolerance.

D danaparoid can be used as an alternative antithrombotic agent in pregnant women with high thrombosis risk and intolerance to heparins, as well as in HIT patients and patients with skin reactions.

Low molecular weight heparin (tinzaparin) therapy for moderate risk thromboprophylaxis during pregnancy. A pharmacokinetic study.

The results suggest that the pharmacokinetics of tinzaparin are affected by pregnancy and larger studies are required to determine whether an increased tinZaparin dose (75 IU/kg) would be more effective in the prevention of thrombosis during pregnancy than 50IU/kg.