Lepirudin for treatment of acute thrombosis during pregnancy.

BACKGROUND: Thromboprophylaxis during pregnancy can be challenging when heparin is contraindicated. Limited data exist regarding alternative anticoagulants in the setting of pregnancy. CASE: We present a patient with antiphospholipid syndrome who developed heparin-induced thrombosis in the third trimester of pregnancy. She was treated with therapeutic doses of intravenous lepirudin until delivery. Induction of labor, regional anesthesia, and forceps-assisted vaginal delivery were performed with no fetal, neonatal, or maternal complications. Postpartum, the patient was transitioned to warfarin therapy, and at 6 weeks postdelivery neither the patient nor her infant had developed any new problems. CONCLUSION: Intravenous lepirudin use at therapeutic doses in late gestation as an alternative to heparin was accomplished with minimal maternal and fetal morbidity.