Management of heparin-associated thrombocytopenia in pregnancy with subcutaneous r-hirudin

Heparin-induced thrombocytopenia type II is a serious, immune-mediated comp lication of heparin therapy. Due to its low cross-reactivity with heparin-a ssociated antibodies (10-20%), danaparoid has successfully been administere d in these patients. In recent studies, r-hirudin as a potent and specific thrombin inhibitor, was demonstrated to be a safe and effective anticoagula nt, We report a pregnant woman with systemic lupus erythematosus and recurr ent venous thromboembolism who suffered from heparin-induced thrombocytopen ia type II while treated with dalteparin sodium. Positive crossreactivities with danaparoid were found. Anticoagulation with 15 mg subcutaneous r-hiru din was performed twice daily from the 25th week of pregnancy until deliver y. No thromboembolism or bleeding or fetal toxicity of r-hirudin was detect ed. Recombinant hirudin is a potent and specific thrombin inhibitor that ca n be used as a safe and effective anticoagulant in pregnancy. Copyright (C) 2000 S. Karger AG, Basel.