Coagulation Disorder Management

Frequently Asked Questions

1. How common are blood clots during pregnancy and how are they treated?
2. Who is at risk for blood clotting during pregnancy?
3. What are the symptoms of blood clotting?
4. How does blood clotting affect pregnancy outcomes?
5. Why is Heparin the prescribed drug of choice for pregnant women with coagulation disorders?
6. How is Heparin administered?
7. What are the benefits of using continuous subcutaneous Heparin therapy?
8. At what gestational age can subcutaneous Heparin therapy be initiated?
9. Are there any side effects associated with Heparin therapy?
10. What are Matria's protocols for coagulation disorder management?
11. What are the benefits of Matria's Coagulation Disorder Management program?

1. How common are blood clots during pregnancy and how are they treated?

Blood clots occur in approximately 23,000 pregnancies each year. They are life-threatening to the mother and one of the major causes of maternal death. Physicians typically prescribe anticoagulant medications, which prevent blood from clotting. Heparin is the most widely prescribed anticoagulant for women who are pregnant.

2. Who is at risk for blood clotting during pregnancy?

There are multiple risk factors, including patients with the following conditions:

• Obesity
• Prolonged bed rest
• Surgical deliveries
• History of blood clots
• A variety of coagulation disorders

3. What are the symptoms of blood clotting?

Symptoms include:

• Pain and tenderness in the limbs
• Swelling and/or warmth in the limbs
• Pain in the calf due to stretching the Achilles tendon

4. How does blood clotting affect pregnancy outcomes?

Pregnant women with coagulation disorders are at risk for poor pregnancy outcomes. While the biggest risk is to mother, who could have a heart attack from a blood clot, infants are also at risk. A blood clot could form in the placenta, cutting off blood flow and resulting in a stillborn birth.

5. Why is Heparin the prescribed drug of choice for pregnant women with coagulation disorders?

Heparin is safe for use in pregnancy unlike most oral anticoagulants, which cross the placental barrier and expose the fetus to serious health risks. Heparin can be used for prevention and treatment of blood clots and does not remain in the body for long, which means dosing can be individually adjusted quickly if necessary.

6. How is Heparin administered?

Heparin cannot be taken by mouth. It must be administered either through intravenous infusion or an injection into the fatty tissues. Matria’s program provides a subcutaneous pump that only needs to be changed every five days. A small needle is inserted under the skin and attached to a microinfusion pump that administers the drug into the fatty tissues on a continuous release basis.

7. What are the benefits of using continuous subcutaneous Heparin therapy?

Without Matria’s subcutaneous pump, women would have to inject themselves at least twice daily, which is painful and causes bruising and tissue damage. Coagulation disorders often require frequent dosing adjustments, and the pump can be easily adjusted to the patient’s needs.

8. At what gestational age can subcutaneous Heparin therapy be initiated?

This depends on the coagulation disorder, the patient's current clinical status, past history and other complications. When prescribed by the patient's physician, therapy can be initiated within eight to 12 weeks and continue up to eight weeks after birth.

9. Are there any side effects associated with Heparin therapy?

Because anticoagulants prevent clotting, they can lead to excess bleeding. Patients may notice that their gums bleed easily or see blood in their urine. Matria’s experienced nurses understand and monitor for this risk by observing frequent laboratory assessments and keeping in close contact with patients. Side effects can be minimized easily by effectively managing dosage levels.

10. What are Matria's protocols for coagulation disorder management?

When Matria’s program is prescribed for a patient, Matria provides:

• An initial home visit that includes home assessment and appropriate patient education
• Nursing support as required
• Provision of equipment and medical supplies as required
• Pharmacy consultations
• Detailed clinical reports

11. What are the benefits of Matria's Coagulation Disorder Management Program?

• Experience/expertise in obstetrical home care
• Comprehensive patient education
• 24-hour support by registered nurses with labor and delivery experience
• Obstetrical pharmacy consultations
• Patient-specific dosing guidelines
• Ambulatory pump technology
• Improved patient compliance
• Detailed clinical reports
• Reduced hospitalizations before birth
• Pregnancy outcomes comparable to hospital management
• Cost savings (based on reduced hospitalizations)