Comparison of 2 Low Molecular Heparin as a Thromboprophylaxis Postpartum

The use of a new generation low molecular weight heparin (Bemiparin)and the well known LMWH (Enoxaparin) after Caesarean sections and vaginal deliveries in a risky group patients for venous thrombosis.

Venous thromboembolism (VTE) is the leading cause of maternal mortality and morbidity in the developed and developing world. Pulmonary embolism and deep vein thrombosis are the two components of a single disease called deep vein thrombosis (DVT). Pregnancy associated with an average 5 to 10 fold increase in the risk of VTE compared with non-pregnant women. The highest incidence occurring during the post partum period. There are many researches done a broad on the effect of LMWH to decrease the incidence of VTE after Caesarean section using the two LMWH (Enoxaparin and Bemiparin) alone but not in one research comparing both of them alone and both together against a control group. Also according to our knowledge there are no published literature on thromboprophylaxis after vaginal delivery

• Drug: Bemiparin
  Bemiparin sodium 3,500 IU anti Xa/0.3 ml solution for injection in pre-filled syringe will be provided for each patient in Bemiparin group; subcutaneously 6 hours after delivery(vaginal and Caesarean)and then daily for up to 7 days.
  Other Name: Hibor; Laboratories Rovi Pharmaceuticals
• Drug: Enoxaparin
  Enoxaparin sodium 40mg (equivalent to 4,000 IU anti-Xa activity) in 0.4ml water for injection will be administered subcutaneously 6 hours after the delivery( vaginal or abdominal)then daily up to 7 days post partum, for Enoxaparin group of patients.
  Other Name: Clexane(Sanofi aventis)

• Active Comparator: Bemiparin
  A new second generation Low Molecular Weight Heparin
  Interventions:

  • Drug: Bemiparin
  • Drug: Enoxaparin
• Active Comparator: Enoxaparin
  A well known Low Molecular Weight Heparin
  Intervention: Drug: Enoxaparin
• No Intervention: control group
  Risky group patients for VTE, but they will not receive any thromboprophylactic drug.

Inclusion Criteria:

• Presence of risk factors for venous thromboembolism
• Any parity
• Mode of delivery:vaginal, Emergency and Elective Caesarean section
• No any contraindications for Heparin

Exclusion Criteria:

• Active antenatal or postpartum vaginal bleeding.
• Placenta previa
• Thrombocytopenia
• Sever renal or liver diseases
• Uncontrolled sever hypertension
• Any patient who is already on Heparin during pregnancy