B HIT During Pregnancy

There are a few reports describing HIT during pregnancy (Meytes et al., 1986; Henny et al., 1986; Copplestone and Oscier, 1987; Calhoun and Hesser, 1987; van Besien et al., 1991; Greinacher et al., 1993a). Danaparoid has been used in at least 32 pregnant women using dosing schedules similar to those in nonpregnant patients (Lindhoff-Last et al., 2005). Danaparoid does not cross the placenta, based on cord blood assessment (see Chapter 13).

Lepirudin, bivalirudin, argatroban, danaparoid, and fondaparinux are category B drugs, i.e., indicating absence of fetal damage in certain high-dose animal studies, but limited (if any) human data. Few reports describe use of lepirudin during pregnancy (Huhle et al., 2000; Furlan et al., 2006). Danaparoid does not appear to cross the placenta (Lagrange et al., 2002; Magnani and Gallus, 2006), while about 10% of the maternal blood concentration of fondaparinux were found in the cord blood of a newborn (Harenberg, 2007). Hirudin can cross the placenta in low doses (Markwardt et al., 1988) and has caused embryopathy in rabbits given high doses of hirudin (Lubenow and Greinacher, 2000). Further, a zebrafish model reveals that thrombin plays a role in embryogenesis (Jagadeeswaran et al., 1997). Thus, danaparoid and fondaparinux may be preferable for treatment of HIT during (early) pregnancy.

Recommendation. If available, danaparoid (and possibly fondaparinux) is preferred for parenteral anticoagulation of pregnant patients with HIT, or in those who have a previous history of HIT (grade 2C).

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