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Assessment of arterial distensibility by automatic pulse wave velocity
measurement. Validation and clinical application studies. Hypertension,
1995. 26:485-490.
- Low molecular weight heparins : a guide to their optimum use in pregnancy.
Drugs, 2002. 62:463-477.
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Influence of L-NAME, acetylcholine
and adenosine on mean blood pressure, pulse pressure and pulse pressure amplification
in rats. Journal of Cardiovascular Pharmacology, 2003.
41:210-8.
- Heart rate and pulse pressure
amplification in hypertensive subjects. American Journal of Hypertension
2003. May;16(5):363-70.
- Gender influence on the relation
between heart rate and aortic stiffness. Journal of Hypertension
2003. 21:555-562
- Pulse pressure and arterial
stiffness in rats: comparison with humans. American Journal of
Physiology - Heart and Circulatory Physiology, 2003. 285(4):H1363-9.
Laurent P, Dussarat
GV, Bonal J, Jego C, Talard P, Bouchiat C, Cellarier G. Low
molecular weight heparins :
a guide to their optimum use in pregnancy. Drugs
2002. 62: 463-477
Abstract :
The incidence of pulmonary embolism
(PE) and venous thromboembolism (VTE) is higher in pregnant patients
than in non-pregnant patients. The incidence of thrombosis in all pregnancies
is reported to be between 0.05 and 1%, and an incidence as high as
3% may be present in women after caesarean section.
Anticoagulant medication
is prescribed during pregnancy in patients presenting with VTE, thrombophilia
abnormalities, or a history of PE or VTE. Since unfractionated heparin
(UH) does not cross the placental barrier, it has become the gold
standard anticoagulant therapy during pregnancy. Oral anticoagulants
may also be prescribed during the second trimester but they cross the
placental barrier. Low molecular weight heparins (LMWH) are effective,
easy to use and have good safety profiles. The practical conditions
of use have yet to be validated for pregnancy settings. In the absence
of an approved indication, LMWH use during pregnancy is therefore the
responsibility of the practitioner.
However,
several studies on LMWH as prophylaxis for PE or VTE have shown that
such products are effective with good safety. Moreover, LMWH use
is associated with reduced frequencies of thrombocytopenia and osteoporosis
compared with UH use. Very few studies on LMWH use for the treatment
of PE or VTE during pregnancy have been published, but the safety
of LMWH use in this setting appears to be good. The review of the
use of LMWH in pregnancy settings includes recommendations on the
practical conditions of use. In the absence of large-scale, randomised,
double-blind trials in such settings (which are needed), we propose
the use of LMWH as prophylaxis for PE and VTE during pregnancy, but
not for the treatment of these conditions. In prophylaxis settings,
dalteparin sodium and enoxaparin sodium have been the most widely
studied LMWH and we believe that priority should therefore be given
to those products. Pending approval of LMWH for use in pregnancy,
the use of LMWH off-label is the practitioner's responsibility.
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last modified on : 25 oct 2005 |
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