Thrombophilic conditions during pregnancy
Authors:
J. Mannová 1; M. Penka 2; P. Štourač 3
Authors‘ workplace:
Anesteziologicko-resuscitační oddělení, Nemocnice Havlíčkův Brod
1; Oddělení klinické hematologie, Fakultní nemocnice Brno a Lékařská fakulta Masarykovy univerzity, Brno
2; Klinika dětské anesteziologie a resuscitace, Fakultní nemocnice Brno a Lékařská fakulta Masarykovy
univerzity, Brno
3
Published in:
Anest. intenziv. Med., 27, 2016, č. 6, s. 380-389
Category:
Overview
The risk of venous thromboembolic events is high during pregnancy due to both the physiologic changes of pregnancy and the additional impact of inherited or acquired thrombophilias. The women with thrombophilia are at increased risk not only of pregnancy-related venous thromboembolism (VTE), but also other pregnancy-related complications, including early and late miscarriage, intrauterine growth retardation, placental abruption and pre-eclampsia. Depending on the type of thrombophilia, personal and family history of VTE and history of complications during pregnancy, prophylactic treatment with low molecular weight heparin or unfractionated heparin is recommended. For women with thrombophilia and history of complications during pregnancy, a combination of low dose aspirin and heparin can increase the probability of live birth. On the other hand, pregnant women on prophylactic or therapeutic anticoagulation require individualized delivery plans addressing the obstetric, anaesthetic and thrombotic concerns.
Keywords:
pregnancy – thrombophilia – prophylaxis – anaesthetic management
Sources
1. Bourjeily, G., Paidas, M., Khalil, H. et al. Pulmonary embolism in pregnancy. Lancet, 2010, 375, p. 500–512.
2. Stone, S. E., Timothy, A., Morris, M. D. Pulmonary embolism during and after pregnancy. Crit. Care Med., 2005, 33, Suppl 10.
3. Greer, I. A. Pregnancy Complicated by Venous Thrombosis. N. Engl. J. Med., 2015, 373, p. 540–547.
4. Greer, I. A. Thrombosis in pregnancy: updates in diagnosis and management. Hematology, 2012, p. 203–207.
5. James, A. H. Venous Thromboembolism in Pregnancy. Arteriocler. Thromb. Vasc. Biol., 2009, 29, p. 326–331.
6. Gherman, R. B., Goodwin, T. M., Leung, B. et al. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet. Gynecol., 1999, 94, p. 730–734.
7. Marik, P. E., Plante, L. A. Venous Thromboembolism Disease and Pregnancy, N. Engl. J. Med., 2008, 359, p. 2025–2033.
8. James, A. H., Tapson, V. F., Golddhaber, S. Z. Thrombosis during pregnancy and the postpartum period. Am. J. Obstet. Gynecol., 2005, 193, p. 216–219.
9. Kamel, H., Navi, B. B., Sriram, N. et al. Risk of a thrombotic event after the 6-week post-partum period. N. Engl. J. Med., 2014, 370, p. 1307–1315.
10. Khan, K. S, Wojdyla, D., Say, L. et al. WHO analysis of causes of maternal death: a systematic review. Lancet, 2006, 367, p. 1066–1074.
11. Simpson, E. L., Lawrenson, R. A., Nightingale, A. L. et al. Venous thrombembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. Br. J. Obstet. Gyneacol., 2001, 108, p. 56–60.
12. Dawood, F. Pregnancy and Thrombophilia. J. Blood Disorders Transf., 2013, 4, 164.
13. Bates, S. M., Middeldorp, S., Rodger, M., James, A. H., Greer, I. A. Guidance for the treatment and prevention of obstetric-associated venous thrombembolism. J. Thromb. Thombolysis, 2016, 41, p. 92–128.
14. Kjellberg, U., Andersson, N. E., Rosen, S. et al. APC resistance and other haemostatis variables during pregnancy and purperium. Thromb. Haemost., 1999, 81, p. 527–531.
15. Battinelli, E. M., Marshall, A., Connors, J. M. The Role of Thrombophilia in Pregnancy Review article. Thrombosis, 2013, ID 516420:1–9.
16. Clark, P., Brennand, J., Conkie J. A. et al. Activated protein C sensitivity, protein C, protein S and coagulation in normal pregnancy. Thromb. Haemost., 1998, 79, p. 1166–1170.
17. Rosendaal, F. R. Risk factors for venous thrombotic disease. Thromb. Haemost. 1999, 82, p. 610–619.
18. Friederich, P.W., Sanson, B.J., Simioni, P. et al. Frequency of pregnancy-related venous thrombembolism in anticoagulant factor-deficient women: implications for prophylaxis. Ann. Int. Med., 1996, 125, p. 955–960.
19. Mahmoodi, B. K., Brouwer, J. L. P., Ten Kate, M. K. et al. A prospective cohort study on the absolute risks of venous thrombembolism and predictive value of screening asymptomatic relatives of patients with hereditary deficiencies of protein S, protein C and antithrombin. J. Thromb. Haemost., 2010, p. 1193–1200.
20. Emmerich, J., Rosendaal, F. R., Cattaneo, M. et al. Combined Effect of Factor V Leiden and Prothrombin 20210A on the Risk of Venous Thrombembolism. Thromb. Haemost., 2001, 86, p. 809–816.
21. Simcox, L. E., Ormesher, L., Tower, C., Greer, I. A. Thrombophilia and Pregnancy Complications. Int. J. of Mol. Sci., 2015, 16, p. 28418–28428.
22. Rey, E., Kahn S. R., Davis, M. et al. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet, 2003, 361, p. 901–908.
23. Robertson, I., Wu, O., Langhorne, P. Thrombophilia in pregnancy: a systematic review. Br. J. Hematol., 2006, 132, p. 171–196.
24. Davenport, W. B., Kutteh, W. Inherited Thrombophilias and Adverse Pregnancy Outcomes. A Review of Screening Patterns and Recommendations. Obstet. Gynecol. Clin. N. Am., 2014, 41, p. 134–144.
25. Roque, H., Paidas, M. J., Funai, E. F. et al. Maternal thrombophilias are not associated with early pregnancy loss. Thrombosis and Haemostasis, 2004, 2, p. 290–295.
26. Shannon, M., Bates, M. D., Greer, I. A. et al. 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, Suppl., e691S–736S.
27. Keeling, D., Mackie, I., Moore, G. W. et al. Guidelines on the investigation and management of antiphospholipid syndrome. Br. J. Haematol. 2012, 157, p. 47–58.
28. Gomez-Puerta, J. A., Espinosa, G., Cervera, R. Catastrophic Antiphospholipid Syndrome Diagnosis and Management in Pregancy. Clin. Lab. Med., 2013, 33, p. 391–400.
29. Dulíček, P., Penka, M., Binder, T. et al. Návrh antitrombotické profylaxe a péče o trombofilní stavy v gynekologii a porodnictví. Doporučení pro klinickou praxi, 2006. Dostupné na www: www.thrombosis.cz.
30. Tang, A.-W., Greer, I. A. A systematic review on the use of the new anticoagulants in pregnancy. Obstet. Med., 2013, 6, p. 64–71.
31. Greer, I. A., Brenner, B., Gris, J. Antithrombotic treatment for pregnancy complications which path for the journey to precision medicine. Br. J. Haematology, 2014, 165, p. 585–599.
32. Rai, R., Cohen, H., Dave, M. et al. Randomized controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospoholipid antibodies.). British medical Journal, 1997, 314, p. 253–257.
33. Kutteh, W. H. Antiphospholipid antiobody associated recurrent pregnancy loss: treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone. Am. J. Obstet. Gynecol., 1996, 174, p. 1584–1589.
34. Goel, N., Tuli, A., Choudhry, R. The role of aspirin versus aspirin and heparin in cases of recurrent abortions with raised anticardiolipin antibodies. Medical Science Monitor, 2006, 12, p. CR132–136.
35. Lockshin, M. D. Anticoagulation in management of antiphospholipid antibody syndrome [APS] in pregnancy. Clin. Lab. Med., 2013, 33, p. 367–376.
36. Jesús, G. R., Rodrigues, G., Jesús, N. R. et al. Pregnancy Morbidity in Antiphospholipid Syndrome: What Is the Impact of Treatment? Curr. Rheumatol. Rep., 2014, 16, p. 403.
37. Greer, I. A., Nelson-Piercy, C. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood, 2005, 106, p. 401–407.
38. Greer, I. A. Low molecular weight heparin for pregnancy complications. Thrombosis Research, 2009, 123, Suppl. 3, S22–S25.
39. Brenner, B., Hoffmann, R., Blumenfeld, A. et al. Gestational outcome in thrombophilic women with recurrent pregnancy loss treated by enoxaprin. Thrombosis and Haemostasis, 2000, 83, p. 693–697.
40. Gris, J. C., Mercier, E., Quéré, I. et al. Low-molecular-weight heparin versus low-dose aspirin in women with one fetal loss and a constitutional thrombophilic disorder. Blood, 2004, 103, p. 3695–3699.
41. Brenner, B., Hoffman, R., Carp, H. et al. Efficacy and safety of two doses of enoxaprin in women with thrombophilia and recurrent pregnancy loss: the LIVE-ENOX study. J. Thrombosis and Haemostasis, 2005, 3, p. 227–229.
42. Carp, H., Dolitzky, M., Inbal, A. Thrombophylaxis improves the live birth rate in women with consecutive recurrent miscarriages and hereditary thrombophilia. J. Thrombosis and Haemostasis, 2003, 1, p. 433–438.
43. Folkeringa, N., Brouwer, J. L., Korteweg, E. J. et al. Reduction of high fetal loss rate by anticoagulant treatment during pregnancy in antithrombin, protein C or protein S deficient women British. J. of Haematology, 2007, 136, p. 656–661.
44. Clark, P., Walker, I. D., Langhorne, P. et al. Scottish Pregnancy Intervention Study (SPIN) study: multicenter, randomized controlled trial of low-molecular-weight heparin and low-dose aspirin in women with recurrent miscarriage. Blood, 2010, 115, p. 4162–4167.
45. Kaandorp, S. P., Goddijn, M., van der Post, J. A. et al. Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. N. Eng. J. Medicine, 2010, 362, p. 1586–1596.
46. Visser, I., Ulander, V. M., Helmerhorst, F. M. et al. Thromboprophylaxes for recurrent miscarriage in women with or without thrombophilia. HABENOX: a randomized multicentre trial. Thrombosis and Haemostasis, 2011, 105, p. 295–301.
47. Tormene, D., Grandone, E., De Stefano, V. et al. Obstetric complication and pregnacy-related venous thrombembolism: the effect of low-molecular-weight heparin on their prevention in carriers of factor V Leiden or prothrombin G 20210A mutation. Thrombosis and Haemostasis, 2012, 107, p. 477–484.
48. Kessler, P. Trombofilní stavy. Interní medicína pro praxi, 2006, 9, p. 374–378.
49. Rupeen, W., Derry, S., McQuay, H. et al. Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidrual analgesia/anesthesia. Anesthesiology, 2006, 105, p. 394–399.
50. Royal College of Obstetricians and Gynecologists Green-top Guideline No. 37b. Thromboembolic disease in pregnancy and the puerperium: acute management, 2015. Dostupné na www: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg37b/
51. Shaikh, N., Ummunnisa, F., Aboobacker, N. et al. Peripartum pulmonary embolism: Anesthetic and surgical considerations. J. Obstet. Gynecol., 2013, 3, p. 158–164.
52. Horlocker, T. T., Wedel, D. J., Roswlingson, J. C. et al. Regional anesthesia in patient receiving antithrombotic or thrombolytic therapy. Regional Anest. and Pain Med., 2010, 35, p. 64–74.
Labels
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2016 Issue 6
Most read in this issue
- Depth of anaesthesia monitoring
- Thrombophilic conditions during pregnancy
- Regional anaesthesia and haemostasis-modifying drugs – latest recommendations
- Preventive immobilisation of the cervical spine in pre-hospital emergency care in trauma patients: update