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Obstetric venous thromboembolism: a systematic review of dalteparin and pregnancy.

Review article
Authors Margareta Hellgren
Oras Mistafa
Published in Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
Volume 39
Issue 4
Pages 439-450
ISSN 1364-6893
Publication year 2019
Published at Institute of Clinical Sciences, Department of Obstetrics and Gynecology
Pages 439-450
Language en
Links dx.doi.org/10.1080/01443615.2018.14...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Obstetrics and gynaecology

Abstract

A systematic review of studies published between 1 January 1985 and 31 August 2017 was performed to analyse the efficacy of the low-molecular-weight heparin, dalteparin, in venous thromboembolism (VTE) treatment and prophylaxis during pregnancy, and to evaluate dosing practices, anticoagulant monitoring and adverse events. A therapeutic dosing throughout pregnancy or followed by reduced doses effectively prevented VTE recurrence. Anti-factor Xa activity was the most commonly used method of dose monitoring. The risk of bleeding with dalteparin was generally minor. Major bleeding was observed when a high dose of dalteparin was employed during (or close to) delivery, or postpartum. Other adverse events were minor. Disparity exists in VTE treatment and thromboprophylaxis, with wide variety in the dosing regimens, treatment strategies and monitoring practices employed. Large randomised controlled trials are warranted but due to ethical reasons, and the rarity of VTE-associated obstetric complications, case-control, registry and large observational studies present more likely options.

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