Shan D, Li T, Tan X, Hu YY. Low-molecular-weight heparin and preeclampsia — does the sword cut both ways? Three case reports and review of literature. World J Clin Cases 2024; 12(9): 1634-1643 [PMID: 38576748 DOI: 10.12998/wjcc.v12.i9.1634]
Corresponding Author of This Article
Ya-Yi Hu, MD, Chairman, Chief Doctor, Director, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20 Renmin South Road, Section 3, Chengdu 610000, Sichuan Province, China. sometreasure@sina.cn
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 26, 2024; 12(9): 1634-1643 Published online Mar 26, 2024. doi: 10.12998/wjcc.v12.i9.1634
Low-molecular-weight heparin and preeclampsia — does the sword cut both ways? Three case reports and review of literature
Dan Shan, Tao Li, Xi Tan, Ya-Yi Hu
Dan Shan, Tao Li, Xi Tan, Ya-Yi Hu, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610000, Sichuan Province, China
Dan Shan, Tao Li, Xi Tan, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, Sichuan, China
Author contributions: Shan D, Hu YY, and Li T made substantial contributions to conception and design; Shan D, Tan X and Li T helped in drafting the manuscript; Hu YY supervised of this study and gave final approval of the version to be published; all authors read and approved the final manuscript.
Supported byNational Natural Science Foundation of China, No. 82301924.
Informed consent statement: Written informed consent was obtained from the three patients for publication of this case series report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ya-Yi Hu, MD, Chairman, Chief Doctor, Director, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20 Renmin South Road, Section 3, Chengdu 610000, Sichuan Province, China. sometreasure@sina.cn
Received: October 20, 2023 Peer-review started: October 20, 2023 First decision: January 25, 2024 Revised: February 3, 2024 Accepted: March 1, 2024 Article in press: March 1, 2024 Published online: March 26, 2024 Processing time: 157 Days and 7.1 Hours
Abstract
BACKGROUND
Low-molecular-weight heparins (LMWH) are the most commonly used anticoagulants during pregnancy. It is considered to be the drug of choice due to its safety in not crossing placenta. Considering the beneficial effect in the improvement of microcirculation, prophylactic application of LMWH in patients with preeclampsia became a trend. However, the bleeding risk related with LMWH in preeclampsia patients has seldomly been evaluated. This current study aimed to identify the potential risks regarding LMWH application in patients with preeclampsia.
CASE SUMMARY
Herein we present a case series of three pregnant women diagnosed with preeclampsia on LMWH therapy during pregnancy. All the cases experienced catastrophic hemorrhagic events. After reviewing the twenty-one meta-analyses, the bleeding risk related with LMWH seems ignorable. Only one study analyzed the bleeding risk of LMWH and found a significantly higher risk of developing PPH in women receiving LMWH. Other studies reported minor bleeding risks, none of these were serious enough to stop LMWH treatment. Possibilities of bleeding either from uterus or from intrabdominal organs in preeclampsia patients on LMWH therapy should not be ignored. Intensive management of blood pressure even after delivery and homeostasis suture in surgery are crucial.
CONCLUSION
Consideration should be given to the balance between benefits and risks of LMWH in patients with preeclampsia.
Core Tip: Benefits and risks of low molecular weight heparins in pregnant patients diagnosed with preeclampsia should be carefully assessed. Strict control of blood pressure is needed to prevent further bleeding events.
