Advertisement

Pharmacy World and Science

, Volume 26, Issue 5, pp 297–300 | Cite as

Adherence to a guideline for coumarins in pregnancy

  • Dieneke van Driel
  • Judit Wesseling
  • Kirsten ter Huurne
  • Lya M. Geven-Boere
  • Frits R. Rosendaal
  • Eveline van der Vee
  • Lolkje T.W. de Jong-van den Berg
Article

Abstract

Objective: To asses the adherence in daily clinical practice to a guideline for anticoagulation during pregnancy.

Methods: The Dutch anticoagulation clinics developed a pregnancy guideline for anticoagulant therapy in order to avoid foetal exposure to coumarins between the 6th and 9th week of gestation. Anticoagulation was studied in 282 prospectively-registered pregnant women, who were treated by 26 different anticoagulation clinics.

Results: The guideline was adhered to in 93% of treated women. Conforming to the guideline, the majority of patients commenced anticoagulation with heparin in the first trimester (n = 81) or started treatment from the second trimester onwards (n = 168). At the time of conception, 31 anticoagulated women were on coumarin treatment. In 13 of these patients (42%), coumarins were withdrawn before the 6th gestational week. In two pregnant women coumarin therapy started unintentionally during the first trimester of gestation.

Conclusion: The present study shows that the guideline under study is useful in daily clinical practice. A careful instruction of women of child-bearing age who need medication remains important.

Consensus recommendations Foetal malformations Guidelines Pharmacoepidemiology The Netherlands 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Van Driel D, Wesseling J, Sauer PJJ, Touwen BCL, Van der Veer E, Heymans HSA. Teratogen update: fetal effects after in utero ex-posure to coumarins. Teratology 2002; 66: 127–40.CrossRefPubMedGoogle Scholar
  2. 2.
    Nelson-Piercy C. Hazards of heparin: allergy, heparin-induced thrombocytopenia and osteoporosis. Baillière Clin Obstet Gyne-col 1997; 11: 489–509.Google Scholar
  3. 3.
    Hanania G, Thomas D, Michel P L, G arbarz E, Age C, Millaire A et al. Pregnancy and prosthetic heart valves: a French coopera-tive retrospective study of 155 cases. Eur Heart J 1994; 15: 1651–8.PubMedGoogle Scholar
  4. 4.
    Stibbe J, van Dijk-Wierda CA. Antistollingsbehandeling in de zwangerschap.[Anticoagulant therapy in pregnancy.] Tromni-bus 1980; 8: 1–6.Google Scholar
  5. 5.
    Gohlke-Barwolf C, Acar J, Oakley C, Butchart E, Burckhart D, Bodnar E et al.Guidelines for prevention of thromboembolic events in valvular heart disease. Study Group of the Working Group on Valvular Heart Disease of the European Society of Car-diology. Eur Heart J 1995; 16: 1320–30.Google Scholar
  6. 6.
    Wesseling J, Van Driel D, Heymans HSA, Rosendaal FR, Geven-Boere LM, Smrkovsky M et al. Coumarins during pregnancy: long-term effects on growth and development of school-age children. Thromb Haemost 2001; 85: 609–13.PubMedGoogle Scholar
  7. 7.
    Statistical Package for the Social Sciences version 7.5 for Windows. Chicago, Illinois: SPSS 1997.Google Scholar
  8. 8.
    Sbarouni E, Oakley CM. Outcome of pregnancy in women with valve prostheses. Br Heart J 1994; 71: 196–201.PubMedGoogle Scholar
  9. 9.
    Robin F, Lecuru F, Desfeux P, Boucay V, Taurelle R. Anticoagulant therapy in pregnancy. Eur J Obstet Gyn Reprod Biol 1999; 83: 171–7CrossRefGoogle Scholar
  10. 10.
    Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PC et al. Why don't physicians follow clinical practice guide-lines? A framework for improvement. JAMA 1999; 282: 1458–65.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Dieneke van Driel
    • 1
  • Judit Wesseling
    • 1
  • Kirsten ter Huurne
    • 2
  • Lya M. Geven-Boere
    • 3
  • Frits R. Rosendaal
    • 4
  • Eveline van der Vee
    • 5
  • Lolkje T.W. de Jong-van den Berg
    • 2
  1. 1.Department of Paediatrics, Beatrix Children’s HospitalUniversity HospitalGroningenThe Netherlands
  2. 2.Department of Social Pharmacy and PharmaepidemiologyGroningen University Institute of Drug Exploration (GUIDE)GroningenThe Netherlands
  3. 3.Dutch Federation of Thrombosis ServicesThe HagueThe Netherlands
  4. 4.Departments of Haematology and Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
  5. 5.Pathology and Laboratory MedicineUniversity Hospital GroningenGroningenThe Netherlands

Personalised recommendations