Book Review

most all’, ‘most common’, ‘thorough evaluation’, ‘many instances’, ‘in appropriate women’ and ‘our experience’ (all scored in the summary of one chapter). Specifically, chapters 1 and 2, dealing with disseminated intravascular coagulation and recurrent miscarriage, respectively, excel in expert opinions rather than evidence-based information. Several chapters (!) contain the same and rather surprising statement from the FDA website dated 2002, regarding the potential teratogenic effects of Lovenox (enoxaparine) in pregnancy. This statement has been disputed years ago, for example by Ginsberg et al., arguing that ‘the potential for teratogenicity of LMWHs lacks biological plausibility because it has been demonstrated that these agents do not cross the placenta. In support of this, a recent comprehensive overview concluded that there was no teratogenicity associated with LMWHs’ [Ginsberg et al.: Anticoagulation of pregnant women with mechanical heart valves. Arch Intern Med 2003; 163: 694]. More importantly, a recent clinical practice guideline on the management of venous thromboembolism from the American College of Physicians and the American Academy of Family Physicians states that ‘neither LMWH nor unfractionated heparin crosses the placenta, and neither is associated with embryopathy or fetal bleeding’ [Ann Fam Med 2007; 5: 75]. Hence, this outdated FDA warning statement should have been avoided in a textbook, in the absence of convincing evidence. In conclusion, as a clinician I do not recommend this book for consulting physicians in hematological problems in gynecology and obstetrics. In spite of the fact that a fairly broad range of relevant topics is discussed, the chapters too often fail to provide balanced and evidence-based information, which make it a book with a very personal touch. Given the track record of Dr. Bick in this area of investigation, a personal touch is unavoidable, but it hinders the reading of this work, which is a pity. H. ten Cate, Maastricht Rodger L. Bick, Eugene P. Frenkel, William F. Baker, Ravi Sarode