Pharmacology and toxicology
Hirudin-like compounds are lepirudine and desirudin. Danaparoid is a heparinoid with a molecular weight of about 6500 daltons, and, based upon molecular weight and similar compounds, it is likely that it will not cross the placenta. These compounds are used in cases of heparin intolerability, such as heparin-induced thrombocytopenia (HIT). In a recent review, use in pregnancy was evaluated; no indications of increased risk of adverse fetal outcome were observed (Lindhoff-Last 2005).
Dipyridamole primarily indicated as a coronary vasodilator (see Chapter 2.8), is also used as a synergistic antithrombotic agent when administered with aspirin, or heparin, in patients with prosthetic heart valves. It has, combined with other anticoagulants, also been investigated in women with essential thrombocythemia, in attempts to reduce the incidence of recurrent abortions and fetal growth retardation. Unfortunately, data arc insufficient for an opinion about its safety (Eliyahu 1997).
Abciximab, clopidogrel, eptibatide, ticlopidine, and tirofiban antagonize platelet aggregation. No data are available about their use during pregnancy. However, it was demonstrated that abciximab did not cross the in vitro perfused human placental lobule because it was degraded by the placenta since it is a chimearic Fab fragment (Miller 2003).
Recommendation. In cases of heparin-induced thrombocytopenia (HIT), danaparoid may be prescribed. When one of the other abovementioned antithrombotics has been used during the first trimester, the termination of pregnancy or invasive diagnostics are not required.
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