Pulsatile heparin administration in pregnancy: a new approach.

The role of anticoagulation during pregnancy for women with a past history of thromboembolism is a controversial issue. The risk of recurrence of thromboembolism, however, is of the magnitude of about 15%, which warrants intervention, especially when one is dealing with such a potentially lethal disease. The analysis of plasma heparin levels is suggested as the best way to monitor treatment. As an alternative to subcutaneous injections twice or three times daily, 15 women used a portable infusion pump (Zyklomat, Ferring) that delivered heparin either subcutaneously or intravenously for periods of up to 25 weeks. There were no recurrencies of thromboembolism and no clinical signs of osteoporosis. The patient acceptability of the pump was excellent as was the ability to maintain adequate heparin levels. Although there are some theoretical benefits with intermittent infusion of heparin evaluation of the advantages from a medical point of view must await further studies.