Intermediate-dose versus low-dose low-molecular-weight heparin in pregnant and post-partum women with a history of venous thromboembolism (Highlow study): an open-label, multicentre, randomised, controlled trial thelancet.com/journals/lance…
We found that the higher dose did not reduce the risk of recurrent #VTE during the entire study period (Pregnancy plus postpartum period), which was unexpected and perhaps due to an over-enthusiastic sample size calculation…
A priori as a secondary endpoint, we noticed a reduction of superficial vein Thrombosis was included. This is important as this is a strong predictor of #VTE and prompts increasing the dose of #LMWH
Interestingly, there was no difference between the doses during Pregnancy, but the higher dose was more efficacious postpartum. This was a posthoc analysis but seems very compelling
So our take is: in pregnant women with a history of #VTE use low-dose #LMWH antepartum, and intermediate dose postpartum. Ideally, confirm in a postpartum #RCT (Highlow2?). Who has the stemina? It will be fun!
Also, we now have rates of recurrence despite thromboprophylaxis that help counsel patients: 2% vs 2.9%.
A very big thank you to all women who participated, and to all Highlow Investigators!! 
Happy to share the fulltext - DM me!
Free access to the full @Highlow paper: authors.elsevier.com/a/1f-1YV-4XHHIc Valid until December 17, 2022, welcome to read or download. No sign up, registration or fees are required.
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