Treatment of acute pulmonary embolism during pregnancy with low molecular weight heparin: three case reports

We report three patients who presented with acute pulmonary embolism (PE) at gestational weeks 13-19. The diagnosis was based on spiral computer tomography of the lungs. In one of the cases, PE was submassive with signs of right ventricle overload. All of the patients were treated with low molecular weight heparin enoxaparine with an initial dose of 1 mg/kg twice daily during 1 month, and therafter with a reduced dose (80%). The target anti-activated factor X levels 3 h after injection were easily kept in the therapeutic range (0.5-0.9 IU/ml). In all cases, the symptoms were relieved within 4 days and no thrombotic or bleeding complications were observed during the rest of the pregnancy. We conclude that low molecular weight heparin seems to be an efficient and practical treatment of PE during pregnancy.