The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Cancer patients exhibit an increased risk of venous thromboembolism (VTE), with VTE being the sec... more Cancer patients exhibit an increased risk of venous thromboembolism (VTE), with VTE being the second leading cause of morbidity and mortality in these patients. The implementation of lockdowns following the COVID-19 pandemic has resulted in decreased mobility and delayed access to care, thus further increasing the susceptibility to VTE. Cancer patients may also be at a higher risk of SARS-CoV-2 infection and have been shown to be more likely to experience severe COVID-19 disease compared to patients without cancer. Given that both cancer and COVID-19 exhibit a hypercoagulable state, stasis of blood flow, and endothelial injury, cancer patients with COVID-19 constitute a vulnerable population with a high risk of thrombosis and bleeding. However, to date there are limited studies evaluating whether cancer patients infected with SARS-CoV-2 have a higher VTE incidence than COVID-19 patients without cancer, how to assess the risk of VTE, prophylaxis and treatment in this special population. Herein, we highlight the urgent need for studies in cancer patients with COVID-19 to ensure appropriate patient care and improve clinical outcomes.
International clinical practice guidelines for the treatment and prophylaxis of thrombosis associ... more International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer.
The introduction of new therapeutic agents for multiple myeloma (MM), including proteasome inhibi... more The introduction of new therapeutic agents for multiple myeloma (MM), including proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies, has improved the outcomes of patients but, in parallel, has changed the frequency and epidemiology of thrombotic events. Thrombosis is now a significant cause of morbidity and mortality in MM patients, and optimal thromboprophylaxis is far from being reached. Moving from the recognition that the above issue represents an unmet clinical need, an expert panel assessed the scientific literature and composed a framework of recommendations for improving thrombosis control in patients who are candidates for active treatment for MM. The panel generated key clinical questions using the criterion of clinical relevance through a Delphi process. It explored four domains, i.e., thrombotic risk factors and risk stratification, primary thromboprophylaxis, management of acute thrombotic events, and secondary thromboprophylaxis. The recommendation...
In cancer patients, thrombocytopenia can result from bone marrow infiltration or from anticancer ... more In cancer patients, thrombocytopenia can result from bone marrow infiltration or from anticancer medications and represents an important limitation for the use of antithrombotic treatments, including anticoagulant, antiplatelet, and fibrinolytic agents. These drugs are often required for prevention or treatment of cancer-associated thrombosis or for cardioembolic prevention in atrial fibrillation in an increasingly older cancer population. Data indicate that cancer remains an independent risk factor for thrombosis even in case of thrombocytopenia, since mild-to-moderate thrombocytopenia does not protect against arterial or venous thrombosis. In addition, cancer patients are at increased risk of antithrombotic drug-associated bleeding, further complicated by thrombocytopenia and acquired hemostatic defects. Furthermore, some anticancer treatments are associated with increased thrombotic risk and may generate interactions affecting the effectiveness or safety of antithrombotic drugs. ...
Background Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic micro... more Background Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy (TMA) requiring urgent treatment. Standardization of its diagnosis and optimal management is challenging. This study aimed to evaluate the role of centralized, rapid testing of ADAMTS13 in patients experiencing acute TMAs requiring plasma-exchange (PEX) and to estimate the incidence of TTP in a large Italian Region. Methods We perfomed a cohort study in the frame of the project “Set-up of a Lombardy network for the study and treatment of patients undergoing apheresis”, including 11 transfusion centers in the Region. Consecutive patients referred from 2014 to 2016 with acute TMAs requiring PEX were enrolled. Centralized ADAMTS13 activity testing was performed at the Milan Hemophilia and Thrombosis Center within 24 h. Results Forty-three TMA patients (44 events) were enrolled, of whom 35 (81%) had severe ADAMTS13 deficiency. Patients with severe ADAMTS13 deficiency were younger,...
Both myeloproliferative neoplasms (MPNs) and coronavirus disease 2019 (COVID-19) are characterize... more Both myeloproliferative neoplasms (MPNs) and coronavirus disease 2019 (COVID-19) are characterized by an intrinsic thrombotic risk. Little is known about the incidence and the outcome of thrombotic events in patients with MPN infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but common mechanisms of coagulation activation, typical of both disorders, suggest that these patients can be at particularly high risk. To define the best thromboprophylaxis and treatment regimens in both MPN and COVID-19, individual- and disease-specific thrombotic risk factors, bleeding risk, and concomitant specific treatments need to be considered. In this case-based review, an individualized approach is presented in a case of SARS-CoV-2 infection occurring in a man with polycythemia vera (PV). A primary anticoagulant thromboprophylaxis strategy and adjustment of his PV treatment were implemented. However, during the hospital stay, he experienced pulmonary embolism and therapeutic a...
Background Direct oral anticoagulants (DOACs) have emerged as a treatment of choice in patients w... more Background Direct oral anticoagulants (DOACs) have emerged as a treatment of choice in patients with chronic atrial fibrillation (AF) or for secondary prevention of venous-thromboembolism (VTE). In myeloproliferative neoplasms (MPN) very small series have been reported and robust data reporting the safety/efficacy profile of these drugs is not available. We conducted an international, multi-country, retrospective study involving 19 hematologic centers from Europe, US and Canada, with the aim to describe in a large cohort of MPN patients the incidence of thrombosis and bleeding complications associated with DOAC use in real word clinical practice. Methods Centers reported in an electronic CRF data on 442 patients (M/F: 221/221; median age: 65 years) with a WHO diagnosis of polycythemia vera (PV, n=178), essential thrombocythemia (ET, n=172) and primary myelofibrosis (PMF, n=92) who had received DOACs (Rivaroxaban n=187; Apixaban n=157; Dabigatran n=50; Edoxaban n=48) for either prima...
In the Philadelphia-negative myeloproliferative neoplasms (MPN), the major burden of disease is t... more In the Philadelphia-negative myeloproliferative neoplasms (MPN), the major burden of disease is the elevated risk of thrombosis . Moreover, MPN patients are concomitantly prone to bleeding [1], making antithrombotic therapy challenging. Regarding atrial fibrillation (AF), very scarce data are available about treatment outcomes with vitamin-K antagonists (VKAs) or direct oral anticoagulants (DOACs) . On the other hand, VKAs partially prevent recurrent venous thromboembolism (VTE), and the incidence of either recurrent thrombosis and major bleeding is still unacceptable high . DOACs emerged as a treatment of choice for secondary prevention of VTE and thrombosis prophylaxis in AF in the general population, and may be an attractive alternative to VKAs in MPN. However, evidence of their efficacy and safety in MPN is very limited and based on few retrospective observational studies , and on scattered information from controlled trials of DOACs versus VKAs.
... We performed two post-hoc analyses of two randomized studies to compare effi cacy, safety and... more ... We performed two post-hoc analyses of two randomized studies to compare effi cacy, safety and overall survival of fondaparinux to standard initial (low molecular weight) heparin treatment in cancer patients with venous thromboembolism. ...
European Journal of Internal Medicine, Oct 1, 2020
Background: Intracranial hemorrhage (ICH) is associated with severe prognosis and recurrent risk.... more Background: Intracranial hemorrhage (ICH) is associated with severe prognosis and recurrent risk. This impacts on the decision to resume anticoagulation in atrial fibrillation (AF) or venous thromboembolism (VTE) patients. Purpose of our study is to evaluate the incidence rate of recurrent ICH in patients with AF or VTE resuming anticoagulation after a first ICH episode. Methods: We report data of two cohorts of AF or VTE after a first ICH. The Vitamin K antagonist (VKA) cohort (166 patients) derives from CHIRONE Study, the direct oral anticoagulant (DOAC) cohort (178 patients) derives from START2-Register Results: The clinical characteristics of the two cohort are similar with the exception of more prevalence of history of previous stroke/TIA in DOAC patients with respect to VKA (p = 0.02) and serum creatinine le-vels>1.5 mg/dL in VKA patients with respect to DOAC(p = 0.0001). The index ICH was spontaneous in 66.4% and in 33.7% among DOAC and VKAs cohort respectively (p = 0.0001). During follow-up, 14 recurrent ICH were recorded; 9 (rate 2.5 × 100 patient-years) in VKA and 5 (rate 1.3 × 100 patient-years) in DOAC (Relative Risk 1.9; 95% CI 0.6-7.4; p = 0.2). The univariate logistic regression analysis showed that patients with recurrent ICH were more frequently males, hypertensive, with a history of previous Stroke/TIA and older than patients without recurrence. VKA patients showed a higher risk of recurrence with respect to DOAC patients (OR 1.9;95% CI 0.7-6.7). Conclusions: A trend toward fewer ICH recurrences was detected among DOACs patients in comparison to the previously reported rate of patients on warfarin.
Introduction: The efficacy and safety of direct oral anticoagulants (DOACs) as treatment alternat... more Introduction: The efficacy and safety of direct oral anticoagulants (DOACs) as treatment alternatives for patients with thrombotic antiphospholipid syndrome (APS) remain controversial. Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared the efficacy and safety of DOACs with vitamin-K antagonists (VKAs) in patients with thrombotic APS. We searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials through April 9, 2022. Main efficacy outcomes were a composite of arterial thrombotic events, and a composite of venous thromboembolic events (VTE). The main safety outcome was major bleeding according to the International Society on Thrombosis and Hemostasis (ISTH) criteria. A random effects model with inverse variance was used for the primary analysis. Risk of bias was assessed using the Cochrane Collaboration criteria. Results: Our search retrieved 253 studies. Four RCTs involving 474 patients were included (Figure). All four RCTs were open-label but had proper random sequence generation and adequate allocation concealment. The DOACs used were rivaroxaban (3 trials) and apixaban (1 trial). The mean percent time in therapeutic range in the warfarin arm among the four studies was 60%. Overall, use of DOACs compared with VKAs was associated with increased odds of composite of arterial thrombotic events (OR 5.64, 95% confidence interval [CI] 1.96-16.27, p =0.001, I 2 = 0%). The odds of subsequent VTE events (OR 1.19, 95% CI 0.31-4.53, p =0.80, I 2 = 0%), or major bleeding (OR 1.02, 95% CI 0.42-2.47, p =0.97, I 2 = 0%) were not significantly different between the two groups. Conclusions: Patients with thrombotic APS randomized to DOACs compared to VKAs appear to have increased risk for arterial thrombosis. No significant differences were observed between patients randomized to DOACs vs VKAs in the risk of subsequent VTE or major bleeding.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Pathophysiology of Haemostasis and Thrombosis, 1998
Venous thromboembolism (VTE) remains an important cause of maternal mortality. For women at high ... more Venous thromboembolism (VTE) remains an important cause of maternal mortality. For women at high risk for VTE during pregnancy, unfractionated heparin (UFH) is currently recommended for VTE prophylaxis as it does not cross the placenta. The authors conducted a randomized, open multicentre trial to compare the safety and efficacy of dalteparin with UFH during pregnancy and the postpartum period. The study involved 107 pregnant women from eight Finnish centres, who had confirmed previous or current VTE. These women were randomized to receive either UFH (n = 56) twice daily subcutaneously or dalteparin (n = 51) once daily subcutaneously. The dose of UFH was adjusted according to repeated APTT measurements in order to prolong APTT levels from 5 to 10 s above the normal upper limit 12 h after the last injection. Dalteparin was administered at an initial starting dose of 5,000-7,500 IU/day which was modified on the basis of anti-factor Xa activity levels and aim at the level of 0.20-0.40 IU/ml, 3 h after the last injection. At one centre bone mineral density (BMD) in the lumbosacral spine was determined by dual X-ray absorptiometry (n = 43). A total of 105 1 Prize-winning poster.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Cancer patients exhibit an increased risk of venous thromboembolism (VTE), with VTE being the sec... more Cancer patients exhibit an increased risk of venous thromboembolism (VTE), with VTE being the second leading cause of morbidity and mortality in these patients. The implementation of lockdowns following the COVID-19 pandemic has resulted in decreased mobility and delayed access to care, thus further increasing the susceptibility to VTE. Cancer patients may also be at a higher risk of SARS-CoV-2 infection and have been shown to be more likely to experience severe COVID-19 disease compared to patients without cancer. Given that both cancer and COVID-19 exhibit a hypercoagulable state, stasis of blood flow, and endothelial injury, cancer patients with COVID-19 constitute a vulnerable population with a high risk of thrombosis and bleeding. However, to date there are limited studies evaluating whether cancer patients infected with SARS-CoV-2 have a higher VTE incidence than COVID-19 patients without cancer, how to assess the risk of VTE, prophylaxis and treatment in this special population. Herein, we highlight the urgent need for studies in cancer patients with COVID-19 to ensure appropriate patient care and improve clinical outcomes.
International clinical practice guidelines for the treatment and prophylaxis of thrombosis associ... more International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer.
The introduction of new therapeutic agents for multiple myeloma (MM), including proteasome inhibi... more The introduction of new therapeutic agents for multiple myeloma (MM), including proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies, has improved the outcomes of patients but, in parallel, has changed the frequency and epidemiology of thrombotic events. Thrombosis is now a significant cause of morbidity and mortality in MM patients, and optimal thromboprophylaxis is far from being reached. Moving from the recognition that the above issue represents an unmet clinical need, an expert panel assessed the scientific literature and composed a framework of recommendations for improving thrombosis control in patients who are candidates for active treatment for MM. The panel generated key clinical questions using the criterion of clinical relevance through a Delphi process. It explored four domains, i.e., thrombotic risk factors and risk stratification, primary thromboprophylaxis, management of acute thrombotic events, and secondary thromboprophylaxis. The recommendation...
In cancer patients, thrombocytopenia can result from bone marrow infiltration or from anticancer ... more In cancer patients, thrombocytopenia can result from bone marrow infiltration or from anticancer medications and represents an important limitation for the use of antithrombotic treatments, including anticoagulant, antiplatelet, and fibrinolytic agents. These drugs are often required for prevention or treatment of cancer-associated thrombosis or for cardioembolic prevention in atrial fibrillation in an increasingly older cancer population. Data indicate that cancer remains an independent risk factor for thrombosis even in case of thrombocytopenia, since mild-to-moderate thrombocytopenia does not protect against arterial or venous thrombosis. In addition, cancer patients are at increased risk of antithrombotic drug-associated bleeding, further complicated by thrombocytopenia and acquired hemostatic defects. Furthermore, some anticancer treatments are associated with increased thrombotic risk and may generate interactions affecting the effectiveness or safety of antithrombotic drugs. ...
Background Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic micro... more Background Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy (TMA) requiring urgent treatment. Standardization of its diagnosis and optimal management is challenging. This study aimed to evaluate the role of centralized, rapid testing of ADAMTS13 in patients experiencing acute TMAs requiring plasma-exchange (PEX) and to estimate the incidence of TTP in a large Italian Region. Methods We perfomed a cohort study in the frame of the project “Set-up of a Lombardy network for the study and treatment of patients undergoing apheresis”, including 11 transfusion centers in the Region. Consecutive patients referred from 2014 to 2016 with acute TMAs requiring PEX were enrolled. Centralized ADAMTS13 activity testing was performed at the Milan Hemophilia and Thrombosis Center within 24 h. Results Forty-three TMA patients (44 events) were enrolled, of whom 35 (81%) had severe ADAMTS13 deficiency. Patients with severe ADAMTS13 deficiency were younger,...
Both myeloproliferative neoplasms (MPNs) and coronavirus disease 2019 (COVID-19) are characterize... more Both myeloproliferative neoplasms (MPNs) and coronavirus disease 2019 (COVID-19) are characterized by an intrinsic thrombotic risk. Little is known about the incidence and the outcome of thrombotic events in patients with MPN infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but common mechanisms of coagulation activation, typical of both disorders, suggest that these patients can be at particularly high risk. To define the best thromboprophylaxis and treatment regimens in both MPN and COVID-19, individual- and disease-specific thrombotic risk factors, bleeding risk, and concomitant specific treatments need to be considered. In this case-based review, an individualized approach is presented in a case of SARS-CoV-2 infection occurring in a man with polycythemia vera (PV). A primary anticoagulant thromboprophylaxis strategy and adjustment of his PV treatment were implemented. However, during the hospital stay, he experienced pulmonary embolism and therapeutic a...
Background Direct oral anticoagulants (DOACs) have emerged as a treatment of choice in patients w... more Background Direct oral anticoagulants (DOACs) have emerged as a treatment of choice in patients with chronic atrial fibrillation (AF) or for secondary prevention of venous-thromboembolism (VTE). In myeloproliferative neoplasms (MPN) very small series have been reported and robust data reporting the safety/efficacy profile of these drugs is not available. We conducted an international, multi-country, retrospective study involving 19 hematologic centers from Europe, US and Canada, with the aim to describe in a large cohort of MPN patients the incidence of thrombosis and bleeding complications associated with DOAC use in real word clinical practice. Methods Centers reported in an electronic CRF data on 442 patients (M/F: 221/221; median age: 65 years) with a WHO diagnosis of polycythemia vera (PV, n=178), essential thrombocythemia (ET, n=172) and primary myelofibrosis (PMF, n=92) who had received DOACs (Rivaroxaban n=187; Apixaban n=157; Dabigatran n=50; Edoxaban n=48) for either prima...
In the Philadelphia-negative myeloproliferative neoplasms (MPN), the major burden of disease is t... more In the Philadelphia-negative myeloproliferative neoplasms (MPN), the major burden of disease is the elevated risk of thrombosis . Moreover, MPN patients are concomitantly prone to bleeding [1], making antithrombotic therapy challenging. Regarding atrial fibrillation (AF), very scarce data are available about treatment outcomes with vitamin-K antagonists (VKAs) or direct oral anticoagulants (DOACs) . On the other hand, VKAs partially prevent recurrent venous thromboembolism (VTE), and the incidence of either recurrent thrombosis and major bleeding is still unacceptable high . DOACs emerged as a treatment of choice for secondary prevention of VTE and thrombosis prophylaxis in AF in the general population, and may be an attractive alternative to VKAs in MPN. However, evidence of their efficacy and safety in MPN is very limited and based on few retrospective observational studies , and on scattered information from controlled trials of DOACs versus VKAs.
... We performed two post-hoc analyses of two randomized studies to compare effi cacy, safety and... more ... We performed two post-hoc analyses of two randomized studies to compare effi cacy, safety and overall survival of fondaparinux to standard initial (low molecular weight) heparin treatment in cancer patients with venous thromboembolism. ...
European Journal of Internal Medicine, Oct 1, 2020
Background: Intracranial hemorrhage (ICH) is associated with severe prognosis and recurrent risk.... more Background: Intracranial hemorrhage (ICH) is associated with severe prognosis and recurrent risk. This impacts on the decision to resume anticoagulation in atrial fibrillation (AF) or venous thromboembolism (VTE) patients. Purpose of our study is to evaluate the incidence rate of recurrent ICH in patients with AF or VTE resuming anticoagulation after a first ICH episode. Methods: We report data of two cohorts of AF or VTE after a first ICH. The Vitamin K antagonist (VKA) cohort (166 patients) derives from CHIRONE Study, the direct oral anticoagulant (DOAC) cohort (178 patients) derives from START2-Register Results: The clinical characteristics of the two cohort are similar with the exception of more prevalence of history of previous stroke/TIA in DOAC patients with respect to VKA (p = 0.02) and serum creatinine le-vels>1.5 mg/dL in VKA patients with respect to DOAC(p = 0.0001). The index ICH was spontaneous in 66.4% and in 33.7% among DOAC and VKAs cohort respectively (p = 0.0001). During follow-up, 14 recurrent ICH were recorded; 9 (rate 2.5 × 100 patient-years) in VKA and 5 (rate 1.3 × 100 patient-years) in DOAC (Relative Risk 1.9; 95% CI 0.6-7.4; p = 0.2). The univariate logistic regression analysis showed that patients with recurrent ICH were more frequently males, hypertensive, with a history of previous Stroke/TIA and older than patients without recurrence. VKA patients showed a higher risk of recurrence with respect to DOAC patients (OR 1.9;95% CI 0.7-6.7). Conclusions: A trend toward fewer ICH recurrences was detected among DOACs patients in comparison to the previously reported rate of patients on warfarin.
Introduction: The efficacy and safety of direct oral anticoagulants (DOACs) as treatment alternat... more Introduction: The efficacy and safety of direct oral anticoagulants (DOACs) as treatment alternatives for patients with thrombotic antiphospholipid syndrome (APS) remain controversial. Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared the efficacy and safety of DOACs with vitamin-K antagonists (VKAs) in patients with thrombotic APS. We searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials through April 9, 2022. Main efficacy outcomes were a composite of arterial thrombotic events, and a composite of venous thromboembolic events (VTE). The main safety outcome was major bleeding according to the International Society on Thrombosis and Hemostasis (ISTH) criteria. A random effects model with inverse variance was used for the primary analysis. Risk of bias was assessed using the Cochrane Collaboration criteria. Results: Our search retrieved 253 studies. Four RCTs involving 474 patients were included (Figure). All four RCTs were open-label but had proper random sequence generation and adequate allocation concealment. The DOACs used were rivaroxaban (3 trials) and apixaban (1 trial). The mean percent time in therapeutic range in the warfarin arm among the four studies was 60%. Overall, use of DOACs compared with VKAs was associated with increased odds of composite of arterial thrombotic events (OR 5.64, 95% confidence interval [CI] 1.96-16.27, p =0.001, I 2 = 0%). The odds of subsequent VTE events (OR 1.19, 95% CI 0.31-4.53, p =0.80, I 2 = 0%), or major bleeding (OR 1.02, 95% CI 0.42-2.47, p =0.97, I 2 = 0%) were not significantly different between the two groups. Conclusions: Patients with thrombotic APS randomized to DOACs compared to VKAs appear to have increased risk for arterial thrombosis. No significant differences were observed between patients randomized to DOACs vs VKAs in the risk of subsequent VTE or major bleeding.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Pathophysiology of Haemostasis and Thrombosis, 1998
Venous thromboembolism (VTE) remains an important cause of maternal mortality. For women at high ... more Venous thromboembolism (VTE) remains an important cause of maternal mortality. For women at high risk for VTE during pregnancy, unfractionated heparin (UFH) is currently recommended for VTE prophylaxis as it does not cross the placenta. The authors conducted a randomized, open multicentre trial to compare the safety and efficacy of dalteparin with UFH during pregnancy and the postpartum period. The study involved 107 pregnant women from eight Finnish centres, who had confirmed previous or current VTE. These women were randomized to receive either UFH (n = 56) twice daily subcutaneously or dalteparin (n = 51) once daily subcutaneously. The dose of UFH was adjusted according to repeated APTT measurements in order to prolong APTT levels from 5 to 10 s above the normal upper limit 12 h after the last injection. Dalteparin was administered at an initial starting dose of 5,000-7,500 IU/day which was modified on the basis of anti-factor Xa activity levels and aim at the level of 0.20-0.40 IU/ml, 3 h after the last injection. At one centre bone mineral density (BMD) in the lumbosacral spine was determined by dual X-ray absorptiometry (n = 43). A total of 105 1 Prize-winning poster.
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