The Impact of Dalteparin (Fragmin®) on Thrombin Generation in Pregnant Women with Venous Thromboembolism: Significance of the Factor V Leiden Mutation

Schambeck M. Christian; Edda Eberl; Ulrich Geisen; Ralf Grossmann; Franz Keller

doi:10.1055/s-0037-1615718

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2001; 85(05): 782-786
DOI: 10.1055/s-0037-1615718

Review Article

Schattauer GmbH

The Impact of Dalteparin (Fragmin^®) on Thrombin Generation in Pregnant Women with Venous Thromboembolism: Significance of the Factor V Leiden Mutation

Schambeck M. Christian

¹Central Laboratory and Blood Coagulation Unit, Medical Department, University of Würzburg

,

Edda Eberl

¹Central Laboratory and Blood Coagulation Unit, Medical Department, University of Würzburg

²Department of Gynecology and Obstetrics, Krankenhaus Weilheim, Germany

,

Ulrich Geisen

¹Central Laboratory and Blood Coagulation Unit, Medical Department, University of Würzburg

,

Ralf Grossmann

¹Central Laboratory and Blood Coagulation Unit, Medical Department, University of Würzburg

,

Franz Keller

¹Central Laboratory and Blood Coagulation Unit, Medical Department, University of Würzburg

› Author Affiliations

Abstract

Summary

Hypercoagulability is observed in patients with inherited thrombophilia, e.g. factor V Leiden (FVL) mutation. Pregnancy represents a hypercoagulable state as well. This study addresses the effects of the FVL mutation on haemostatic activation during pregnancy as indicated by prothrombin fragments (F1+2). 233 pregnant women with no history of venous thromboembolism were studied. Additionally, two patient groups (25 pregnant FVL carriers and 36 pregnant women without thrombophilic diathesis) in whom low molecular weight heparin (dalteparin) was used prophylactically against rethrombosis were investigated.

None of the women developed clinical signs of venous thromboembolism during pregnancy or after delivery. Untreated women exhibited substantial hypercoagulability. F1+2 levels were similar in FVL carriers and non-carriers (difference n. s.). After sufficient adjustment for anti-factor Xa activity (≥0.15; ≤0.4 U/mL), heparinized women without any thrombophilic diathesis had significantly lower levels of F1+2 than untreated pregnant women. This was evident only in the first and second trimenon (p <0.01). F1+2 levels in heparinized FVL carriers were quite similar to the levels observed in untreated pregnant women, however. In conclusion, our data support the thesis that in comparison to asymptomatic patients, thrombin generation is exaggerated in symptomatic FVL carriers. Coagulation activation during pregnancy can be reduced by dalteparin.

Keywords

Pregnancy - thromboembolism - thrombophilia - low molecular weight heparin

Full Text

References

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