Successful use of danaparoid in treatment of heparin-induced thrombocytopenia during twin pregnancy

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Abstract
Background: The treatment of heparin-induced thrombocytopenia in pregnancy is uncertain. Warfarin is contraindicated and ancrod is of unknown safety. Low-molecular-weight heparin should not be used because of crossreactivity with unfractionated heparin. We report a case of heparin-induced thrombocytopenia during pregnancy treated successfully with danaparoid. Case: A 25-year-old woman pregnant with twins developed heparin-induced thrombocytopenia after starting heparin therapy for a deep vein thrombosis. Treatment was initiated with danaparoid by subcutaneous injection and was continued until the time of delivery. Treatment was completed with 6 weeks of warfarin therapy postpartum. No fetal or maternal ill effects were observed. Conclusion: Danaparoid, which has low cross-reactivity for heparin-dependent antibodies and no known fetopathic effects, was used successfully to treat our patient, who developed heparin-induced thrombocytopenia during pregnancy. Danaparoid may be the treatment of choice for this difficult clinical situation in which there are limited therapeutic options.

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