Management of acute heparin-induced thrombocytopenia type II during pregnancy and peripartally

In pregnancy and in puerperium heparin is prescribed only for acute thromboembolism and/or for female patients with a clearly increased risk of venous thromboembolism. Since treatment changed from unfractionated heparin to low-molecular-weight heparin, the incidence of heparin-induced thrombocytopenia type II (HIT type II) is therefore a rare event in this collective. HIT type II is a life threatening side effect of heparin which must immediately lead to the stop of heparin administration. Experiences with alternative anticoagulation in pregnancy and puerperium are limited. Oral anticoagulation with coumarin (vitamin K antagonists) is contraindicated for the initial therapy of HIT II. The treatment with these substances is dangerous, especially in the phase of organogenesis, because it can cause malformation and because of the elevated maternal and the child intra-and peripartal bleeding risk in the 2nd half of the third trimenon. Danaparoid Sodium and recombinant Hirudin represent treatment options, whereby because of the better data and the intravenous and especially the subcutaneous application form the application of Danaparoid in the therapy of HIT typ II in pregnancy would appear to be more favourable. In the puerperium Warfarin or Phenprocoumon represent the therapy of choice. Breast-feeding is possible with this option. We report on a female patient with an acute thrombosis of the cerebral sinus vein during early pregnancy who developed a HIT type II under heparin treatment. The long-term anticoagulation with Danaparoid Sodium and the peripartale management are presented.