Management of heparin allergy during pregnancy with danaparoid

• Published in: Blood coagulation & fibrinolysis Vol. 12; no. 2; pp. 157 - 159
• Main Authors: Harrison, S J, Rafferty, I, McColl, M D
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Lippincott Williams & Wilkins, Inc 01-03-2001; The Scientist
• Subjects: Adult; Biological and medical sciences; Cesarean Section; Chondroitin Sulfates - administration & dosage; Chondroitin Sulfates - analysis; Chondroitin Sulfates - therapeutic use; Dermatan Sulfate - administration & dosage; Dermatan Sulfate - analysis; Dermatan Sulfate - therapeutic use; Drug Combinations; Drug Hypersensitivity; Drug toxicity and drugs side effects treatment; Enoxaparin - adverse effects; Enoxaparin - therapeutic use; Factor V - genetics; Factor Xa Inhibitors; Female; Gestational Age; Heparitin Sulfate - administration & dosage; Heparitin Sulfate - analysis; Heparitin Sulfate - therapeutic use; Heterozygote; Humans; Injections, Subcutaneous; Medical sciences; Milk, Human - chemistry; Miscellaneous (drug allergy, mutagens, teratogens...); Mutation; Pharmacology. Drug treatments; Pregnancy; Venous Thrombosis - drug therapy; Human; Immunopathology; Skin disease; Toxicity; Urticaria; Sex; Cardiovascular disease; Low molecular weight heparin; Anticoagulant; Thrombosis; Enoxaparin sodium; Venous disease; Vascular disease; Pregnancy; Chemotherapy; Treatment; Female; Deep vein; Danaparoid sodium
• ISSN: 0957-5235; 1473-5733
• DOI: 10.1097/00001721-200103000-00011

We report a patient who presented with a left proximal deep vein thrombosis at 25 + 5 weeks gestation. She developed a severe urticarial rash 3 weeks following initiation of therapy with Enoxaparin. The patient was heterozygous for the factor V Leiden mutation. She was treated with subcutaneous twice-daily danaparoid (Orgaran) for the remainder of the pregnancy, achieving anti-Xa levels in the therapeutic range 0.5-1.0 IU/ml. Delivery was at term by caesarean section 2 days after spontaneous rupture of membranes and failure to progress in labour. Danaparoid was withheld during this time. Danaparoid was restarted 3 h post delivery and the patient anticoagulated with warfarin in the post-partum period. There was no recurrence of thrombosis or bleeding events during therapy with danaparoid. No anti-Xa activity was demonstrated in breast milk.