PMID- 31347027
OWN - NLM
STAT- MEDLINE
DCOM- 20200317
LR  - 20200317
IS  - 1865-3774 (Electronic)
IS  - 0925-5710 (Linking)
VI  - 110
IP  - 5
DP  - 2019 Nov
TI  - A less-intensive anticoagulation protocol of therapeutic unfractionated heparin 
      administration for pregnant patients.
PG  - 550-558
LID - 10.1007/s12185-019-02712-z [doi]
AB  - Heparin anticoagulant therapy for thromboembolic disorders during pregnancy is 
      problematic due to unexpected adverse bleeding. To avoid bleeding, we have used a 
      less-intensive anticoagulation protocol of unfractionated heparin (UFH). The 
      protocol had a therapeutic activated partial thromboplastin time (APTT) ratio of 
      1.5-2.0 with the control value, a UFH dose of </= 30,000 U/day, and an antithrombin 
      (AT) activity target of >/= 70%. In the present study, we evaluated this protocol 
      using an anti-Xa assay. We collected UFH-treated plasma samples from ten 
      consecutive pregnant Japanese patients with current or previous thromboembolic 
      disorders. Seven patients remained in the therapeutic APTT ratio range 
      (heparin-sensitive [HS] group). The other three patients had difficulty remaining 
      within the therapeutic range (heparin-resistant [HR] group). In the HR group, two 
      had AT deficiency and one had congenital absence of the inferior vena cava. Of 
      the HS and HR samples, 73% and 31%, respectively, were within the therapeutic 
      anti-Xa activity range 0.3-0.7 U/mL, indicating difficulty for the HR group to 
      remain within the therapeutic range. Neither major bleeding nor symptomatic 
      thromboembolic episodes occurred in either group. These findings suggest that the 
      less-intensive anticoagulation protocol is permissive and may be beneficial in 
      the HS group.
FAU - Neki, Reiko
AU  - Neki R
AUID- ORCID: 0000-0002-4660-2782
AD  - Division of Counseling for Medical Genetics, National Cerebral and Cardiovascular 
      Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan. rneki@ncvc.go.jp.
AD  - Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular 
      Center, Suita, Osaka, Japan. rneki@ncvc.go.jp.
FAU - Mitsuguro, Mana
AU  - Mitsuguro M
AD  - Laboratory of Clinical Chemistry, National Cerebral and Cardiovascular Center, 
      Suita, Osaka, Japan.
FAU - Okamoto, Akira
AU  - Okamoto A
AD  - Laboratory of Clinical Chemistry, National Cerebral and Cardiovascular Center, 
      Suita, Osaka, Japan.
FAU - Ida, Kazufumi
AU  - Ida K
AD  - Division of Counseling for Medical Genetics, National Cerebral and Cardiovascular 
      Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan.
FAU - Miyoshi, Takekazu
AU  - Miyoshi T
AD  - Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular 
      Center, Suita, Osaka, Japan.
FAU - Kamiya, Chizuko
AU  - Kamiya C
AD  - Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular 
      Center, Suita, Osaka, Japan.
FAU - Iwanaga, Naoko
AU  - Iwanaga N
AD  - Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular 
      Center, Suita, Osaka, Japan.
FAU - Miyata, Toshiyuki
AU  - Miyata T
AD  - Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular 
      Center, Suita, Osaka, Japan.
FAU - Yoshimatsu, Jun
AU  - Yoshimatsu J
AD  - Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular 
      Center, Suita, Osaka, Japan.
LA  - eng
GR  - grants #23-6-8/the Intramural Research Fund of the National Cerebral and 
      Cardiovascular Center of Japan/
GR  - #25-6-8/the Intramural Research Fund of the National Cerebral and Cardiovascular 
      Center of Japan/
GR  - #27-6-27/the Intramural Research Fund of the National Cerebral and Cardiovascular 
      Center of Japan/
GR  - #JP18K09277/Japan Society for the Promotion of Science KAKENHI grant/
PT  - Journal Article
DEP - 20190725
PL  - Japan
TA  - Int J Hematol
JT  - International journal of hematology
JID - 9111627
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/administration & dosage/adverse effects
MH  - Factor Xa Inhibitors/blood
MH  - Female
MH  - Hemorrhage/chemically induced/prevention & control
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Japan
MH  - Partial Thromboplastin Time
MH  - Pregnancy
MH  - Pregnancy Complications, Cardiovascular/*drug therapy
MH  - Pregnancy Complications, Hematologic/chemically induced/prevention & control
MH  - Thromboembolism/*drug therapy
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - Activated partial thromboplastin time
OT  - Nomogram
OT  - Pregnancy
OT  - Unfractionated heparin
OT  - Venous thromboembolism
EDAT- 2019/07/28 06:00
MHDA- 2020/03/18 06:00
CRDT- 2019/07/27 06:00
PHST- 2019/01/22 00:00 [received]
PHST- 2019/07/18 00:00 [accepted]
PHST- 2019/07/18 00:00 [revised]
PHST- 2019/07/28 06:00 [pubmed]
PHST- 2020/03/18 06:00 [medline]
PHST- 2019/07/27 06:00 [entrez]
AID - 10.1007/s12185-019-02712-z [pii]
AID - 10.1007/s12185-019-02712-z [doi]
PST - ppublish
SO  - Int J Hematol. 2019 Nov;110(5):550-558. doi: 10.1007/s12185-019-02712-z. Epub 
      2019 Jul 25.