Anticoagulation Management Of Dvt In Pregnancy: Anti-Xa Levels Matter
Joann Lohr1, Joseph Caprini, MD2.
1Lohr Surgical Specialists, Cincinnati, OH, USA, 2Venous Resource Center, Chicago, IL, USA.
OBJECTIVES: Confusion has occurred around the need to follow Anti-Xa levels in patients receiving low molecular weight Heparin therapy.
METHODS: Retrospective chart review of three patients in third trimester of pregnancy was performed.
RESULTS: All these were treated with low molecular weight Heparin for a symptomatic proximal ileofemoral DVT occurring in the third trimester of pregnancy. Initially no Anti-Xa levels were drawn but they were treated with weight based protocol (2 received 1 mg/kg BID and one received 1.5mg/kg every 24 hours). All three had worsening swelling, thrombus propagation pain and numbness. Anti-Xa adjustments to therapeutic range resulted in decreased pain, resolution of neurologic symptoms and thrombus stabilization.
CONCLUSIONS: Confusion exists concerning management parameters and need for monitoring of Anti-Xa Levels. Indication for therapy is the key decision making point. All patients active acute DVT should be monitored for therapeutic effect. This is critically important in the late stages of pregnancy.
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