Objective: 39 mothers succumbed to thromboembolism during the 2006-8 triennium in Malaysia, with similarly alarming trends observed in Asia-Pacific and Western countries alike. The significance of this condition is magnified in part, by the reduction in ‘traditional’ causes of maternal deaths such as haemorrhage and hypertensive disorders in pregnancy. A state-wide, documented, serial risk assessment programme has been in place since 2013, whereby women at risk were offered low molecular weight heparin (LMWH) as the first line pharmacological thromboprophylaxis. The benefits and safety of LMWH over unfractionated heparin and pentasaccharide has been adequately chronicled elsewhere. However, the manufacturing of LMWH involves cleavage of heparin derived from porcine intestinal mucosa, which may be of a concern to a section of the population. We examined the acceptability of LMWH amongst Muslim patients in the state.

Methods: A retrospective review of 2,500 consecutive deliveries across three minor specialist district hospitals in Sarawak was performed. This was part of a larger study looking into the indications and uptake of obstetric thromboprophylaxis. Eligible patients were identified from the respective registries in Hospital Sri Aman, Hospital Sarikei and Hospital Kapit. These were then counter-checked with the electronic discharge notification and Informatik Kesihatan Sarawak (Sarawak Health Informatics) to ensure additional cases were not undetected. Confirmation of the patient’s professed faith was based on the information contained in the registry or database above. In cases of ambiguity, case notes were traced for confirmation.

Results: A total of 770 women who fulfilled the threshold criteria for thromboprophylaxis, of whom 164 (21.3%) were of Islamic faith. Of the 164 women, 115 (70.1%) opted for LMWH and 47 (28.6%) preferred unfractionated heparin. Two patients declined any form of thromboprophylaxis, one citing neonatal concerns while another opted for just mechanical thromboprophylaxis. Approximately half of the patients in our rural population opted for injections in their local clinic rather than self-administration.

Conclusion: With appropriate and comprehensive counselling, the majority of Muslim mothers opted for LMWH. This would reduce the burden of repeated platelet monitoring for heparin-induced thrombocytopenia associated with unfractionated heparin. The information obtained from this study allowed better estimation of LMWH use in individual units and ensured a continuous chain of supply from resource-limited district pharmacies. Our findings however, cannot be generalized to the rest of the country, as religious edicts are under the purview of respective states and may influence the women or her partner’s perception.