Therapeutic Options in Pregnant Women with Thrombophilia Depending on the Genetic Mutations- a Prospective Study

Overview

Journal Curr Health Sci J

Specialty General Medicine

Date 2019 Jan 17

PMID 30647950

Authors

J G Nacea

I Rotaru

A M Patrascu

N Cernea

Affiliations

Soon will be listed here.

Abstract

The aim is to evaluate the effects of anticoagulant therapy (Enoxaparine) compared to antiaggregant therapy (Aspirin) on pregnancy outcome depending on the mutational status of clotting factors. The study was conducted prospectively over a 2 years period and included 110 pregnant women, of whom 80 patients diagnosed with hereditary thrombophilia and 30 healthy pregnant women, representing the control group. After careful observation, we concluded a positive influence of Enoxaparine on pregnancy outcome in pregnant women homozygous carriers for factor V Leiden gene mutation and compound heterozygous for Factor V Leiden and Prothrombin G20210A gene mutation. The study did not find significant positive results in women with heterozygous Factor V Leiden and G20210A prothrombin gene mutation who received anticoagulant therapy as well as pregnant women who received low-dose Aspirin compared with controls.

References

Rosendaal F . Risk factors for venous thrombotic disease. Thromb Haemost. 1999; 82(2):610-9. View

Girolami A, Scarano L, Tormene D, Cella G . Homozygous patients with the 20210 G to A prothrombin polymorphism remain often asymptomatic in spite of the presence of associated risk factors. Clin Appl Thromb Hemost. 2001; 7(2):122-5. DOI: 10.1177/107602960100700208. View

Ogueh O, Chen M, Spurll G, Benjamin A . Outcome of pregnancy in women with hereditary thrombophilia. Int J Gynaecol Obstet. 2001; 74(3):247-53. DOI: 10.1016/s0020-7292(01)00447-7. View

Alfirevic Z, Roberts D, Martlew V . How strong is the association between maternal thrombophilia and adverse pregnancy outcome? A systematic review. Eur J Obstet Gynecol Reprod Biol. 2002; 101(1):6-14. DOI: 10.1016/s0301-2115(01)00496-1. View

Pabinger I, Grafenhofer H, Kyrle P, Quehenberger P, Mannhalter C, Lechner K . Temporary increase in the risk for recurrence during pregnancy in women with a history of venous thromboembolism. Blood. 2002; 100(3):1060-2. DOI: 10.1182/blood-2002-01-0149. View

Brenner B, Bar J, Ellis M, Yarom I, Yohai D, Samueloff A . Effects of enoxaparin on late pregnancy complications and neonatal outcome in women with recurrent pregnancy loss and thrombophilia: results from the Live-Enox study. Fertil Steril. 2005; 84(3):770-3. DOI: 10.1016/j.fertnstert.2005.03.048. View

Robertson L, Wu O, Langhorne P, Twaddle S, Clark P, Lowe G . Thrombophilia in pregnancy: a systematic review. Br J Haematol. 2006; 132(2):171-96. DOI: 10.1111/j.1365-2141.2005.05847.x. View

Khan S, Dickerman J . Hereditary thrombophilia. Thromb J. 2006; 4:15. PMC: 1592479. DOI: 10.1186/1477-9560-4-15. View

Selby R, Geerts W . Prevention of venous thromboembolism: consensus, controversies, and challenges. Hematology Am Soc Hematol Educ Program. 2009; :286-92. DOI: 10.1182/asheducation-2009.1.286. View

10.

Said J, Higgins J, Moses E, Walker S, Borg A, Monagle P . Inherited thrombophilia polymorphisms and pregnancy outcomes in nulliparous women. Obstet Gynecol. 2009; 115(1):5-13. DOI: 10.1097/AOG.0b013e3181c68907. View

11.

Baglin T, Gray E, Greaves M, Hunt B, Keeling D, Machin S . Clinical guidelines for testing for heritable thrombophilia. Br J Haematol. 2010; 149(2):209-20. DOI: 10.1111/j.1365-2141.2009.08022.x. View

12.

Ageno W, Gallus A, Wittkowsky A, Crowther M, Hylek E, Palareti G . Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e44S-e88S. PMC: 3278051. DOI: 10.1378/chest.11-2292. View

13.

Bates S, Greer I, Middeldorp S, Veenstra D, Prabulos A, Vandvik P . VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e691S-e736S. PMC: 3278054. DOI: 10.1378/chest.11-2300. View

14.

Simone B, De Stefano V, Leoncini E, Zacho J, Martinelli I, Emmerich J . Risk of venous thromboembolism associated with single and combined effects of Factor V Leiden, Prothrombin 20210A and Methylenetethraydrofolate reductase C677T: a meta-analysis involving over 11,000 cases and 21,000 controls. Eur J Epidemiol. 2013; 28(8):621-47. PMC: 3935237. DOI: 10.1007/s10654-013-9825-8. View

15.

. ACOG Practice Bulletin No. 138: Inherited thrombophilias in pregnancy. Obstet Gynecol. 2013; 122(3):706-17. DOI: 10.1097/01.AOG.0000433981.36184.4e. View

16.

Di Minno M, Dentali F, Lupoli R, Ageno W . Mild antithrombin deficiency and risk of recurrent venous thromboembolism: a prospective cohort study. Circulation. 2013; 129(4):497-503. DOI: 10.1161/CIRCULATIONAHA.113.003756. View

17.

Bellussi F, Contro E, Legnani C, Galletti S, Cosentino A, Rizzo N . Obstetric implications of fetal inherited thrombophilia in thrombophilic women. Pregnancy Hypertens. 2015; 4(1):54-8. DOI: 10.1016/j.preghy.2013.11.001. View

18.

Kearon C, Akl E, Ornelas J, Blaivas A, Jimenez D, Bounameaux H . Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016; 149(2):315-352. DOI: 10.1016/j.chest.2015.11.026. View

19.

Gerhardt A, Scharf R, Greer I, Zotz R . Hereditary risk factors for thrombophilia and probability of venous thromboembolism during pregnancy and the puerperium. Blood. 2016; 128(19):2343-2349. PMC: 5813719. DOI: 10.1182/blood-2016-03-703728. View

20.

Croles F, Nasserinejad K, Duvekot J, Kruip M, Meijer K, Leebeek F . Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and bayesian meta-analysis. BMJ. 2017; 359:j4452. PMC: 5657463. DOI: 10.1136/bmj.j4452. View