REPLY
Pregnancy-Related Thromboembolism
Martin H. Prins, MD, PhD
15 July 1997 | Volume 127 Issue 2 | Page 164
IN RESPONSE:
Dr. Manoharan addresses the important issue of the use of a drug when there is no formal knowledge of safety in a specific situation. The experience with low-molecular-weight heparin in pregnancy was obtained while the pharmaceutical companies advised against use of the drug during pregnancy [1, 2]. One report has indicated that low-molecular-weight heparin, like unfractionated heparin, does not appear in breast milk [3]. Moreover, heparin is not easily absorbed and thus when given orally is unlikely to cause any adverse effects.
We thank Brickner and colleagues for pointing out a mathematical error that escaped our attention when we reviewed the galley proofs of our article. The numbers in the second paragraph of the introduction should read 0.018%, 0.013% to 0.07%, and 0.061% to 0.23%, respectively. Thus, Brickner and colleagues' findings agree with the existing literature on the incidence of pregnancy-related venous thromboembolism in the general population.
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Author and Article Information
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Academic Medical Center, University of Amsterdam; Amsterdam, the Netherlands
1. Rasmussen C, Wadt J, Jacobsen B. Thromboembolic prophylaxis with LMWH during pregnancy. Int J Gynecol Obstet. 1994; 47:121-5.
2. Melissari E, Parker CJ, Wilson NV, et al. Use of LMWH in pregnancy. Thromb Haemost. 1992; 68:652-6.
3. Harenberg J, Leber G, Zimmermann R, Schmidt W. Thromboembolieprophylaxe mit niedermolekularem Heparin in der Schwangerschaft. Geburtsh u Frauenheilk. 1987:47:15-8.
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