Apixaban therapy in a pregnant woman with heparin-induced thrombocytopenia and venous thromboembolic events caused by congenital antithrombin deficiency: A case report

• Published in: Case reports in women's health 2020-07, Vol.27, p.e00200, Article e00200
• Main Authors: Komori, Mayuko, Hayata, Eijiro, Nakata, Masahiko, Yuzawa, Hitomi, Oji, Ayako, Morita, Mineto
• Format: Article
• Language: English
• Subjects: Anticoagulants; Antithrombin deficiency; Heparin-induced thrombocytopenia; Pregnancy; Venous thrombosis
• ISSN: 2214-9112; 2214-9112
• DOI: 10.1016/j.crwh.2020.e00200

We report the case of a 35-year-old pregnant woman (gravida 3, para 1) with antithrombin deficiency who was successfully treated with apixaban. She had a history of heparin-induced thrombocytopenia and venous thromboembolic events. Pregnancy was confirmed while the patient was having anticoagulant therapy for a persistent thrombus. Choice of anticoagulation during her pregnancy was limited because of her antithrombin deficiency: heparin was not an option because of her history of heparin-induced thrombocytopenia; antithrombin-dependent anticoagulant drugs were not an option because of her antithrombin deficiency, and she preferred outpatient management. Despite the fact that there are no reports of its use in pregnant women, we selected apixaban (10 mg/day), a direct Xa inhibitor, as the best solution. No progression of thrombus was noted during the pregnancy. The newborn baby had no external congenital anomalies, intracranial hemorrhage, or bleeding tendency. Thus, apixaban may be a candidate for anticoagulant therapy in pregnant women with a history of venous thromboembolic events and heparin-induced thrombocytopenia. •Pregnant women are at higher risk for venous thromboembolism than women who are not pregnant.•Anticoagulant therapy is limited for a pregnant woman with heparin-induced thrombocytopenia caused by congenital antithrombin deficiency.•Apixaban may be an alternative option of anticoagulant therapy during pregnancy.