Archive for the ‘LMWH’ Category
Stephan Moll, MD writes… LMWH (low molecular weight heparin) is the preferred anticoagulant in the pregnant patient. LMWH and warfarin are safe in the woman who is beast-feeding.
Rivaroxaban (Xarelto), dabigatran (Pradaxa) and apixaban (Eliquis) should not be used during pregnancy or while breastfeeding.
Stephan Moll, MD writes… The FDA published today a drug safety recommendation to decrease bleeding and paralysis risk for patients receiving epidural catheters and being treated with LMWH (detailed FDA report is here). While in many parts of the document the FDA talks specifically about enoxaparin, the communication states that “these new timing recommendations….. will be added to the labels of anticoagulant drugs known as LMWH, including Lovenox and generic enoxaparin products and similar products”. The recommendations are as follows: Read the rest of this entry »
Once or twice daily injections of s.c. anticoagulants for prolonged periods of time can be bothersome and unacceptable for the patient. Use of a once weekly exchanged s.c. port, called Insuflon, can make longer-term s.c. anticoagulant therapy easier and more tolerable. Read the rest of this entry »
How common is pregnancy loss? What are the causes?
Pregnancy loss in the general population is common. Most losses occur in the first trimester. As many as 5 % of women have 2 or more early losses; 1-2 % have 3 or more early losses [ref 1]. Well established risk factors for pregnancy loss are: (a) advanced maternal age, (b) anatomic uterine abnormalities (fibroids, septum, etc), (c) chromosome abnormalities of fetus, mother or father, (d) comorbid diseases of the mother (endocrine, immunologic). The acquired antiphospholipid antibody syndrome is also a risk factor for pregnancy loss. The role of inherited thrombophilias contributing to pregnancy loss is less clear. Read the rest of this entry »
Occasionally, a patient is treated with long-term low molecular weight heparin (LMWH) (enoxaparin = Lovenox®; Dalteparin = Fragmin®; Tinzaparin = Innohep®) . LMWH may be given because the patient (a) tolerated warfarin poorly (widely fluctuating INRs; significant side-effects, such as marked hair loss or fatigue), (b) had a recurrent thrombotic event which occured with a therapeutic INR, or (c) is pregnant and needs an anticoaglant because of an increased risk for thrombosis. The main side-effect of long-term LMWH is, of course, bleeding.
Whether LMWH cause osteoporosis is not known, Read the rest of this entry »