Pulsatile heparin administration in pregnancy: a new approach

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Pharmacology

Background:

• Anticoagulation during pregnancy for women with prior thromboembolism is controversial.
• Recurrence risk of thromboembolism is approximately 15%, necessitating intervention for this potentially lethal condition.
• Monitoring plasma heparin levels is recommended for effective treatment.

Purpose of the Study:

• To evaluate the efficacy and patient acceptability of a portable infusion pump for heparin administration in pregnant women with a history of thromboembolism.
• To assess the safety of continuous heparin infusion via a portable pump, specifically regarding thromboembolism recurrence and osteoporosis.

Main Methods:

• Fifteen women with a history of thromboembolism used a portable infusion pump (Zyklomat, Ferring) for heparin delivery (subcutaneous or intravenous) for up to 25 weeks.
• Plasma heparin levels were monitored to ensure adequate anticoagulation.
• Thromboembolism recurrence and clinical signs of osteoporosis were assessed.

Main Results:

• No recurrences of thromboembolism were observed in the study group.
• No clinical signs of osteoporosis were reported.
• Patient acceptability of the portable pump was excellent.
• Adequate therapeutic heparin levels were consistently maintained.

Conclusions:

• A portable infusion pump offers an effective and well-accepted alternative to frequent subcutaneous heparin injections for pregnant women with a history of thromboembolism.
• This method of heparin delivery appears safe, preventing thromboembolism recurrence and osteoporosis.
• Further studies are needed to evaluate the theoretical benefits of intermittent heparin infusion from a medical perspective.