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Obstetric complications and pregnancy-related venous thromboembolism: The effect of low-molecular-weight heparin on their prevention in carriers of factor V Leiden or prothrombin G20210A mutation

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
DOI: http://dx.doi.org/10.1160/TH11-07-0470
Issue: 2012: 107/3 (Mar) pp. 397-599
Pages: 477-484

Obstetric complications and pregnancy-related venous thromboembolism: The effect of low-molecular-weight heparin on their prevention in carriers of factor V Leiden or prothrombin G20210A mutation

D. Tormene (1), E. Grandone (2), V. De Stefano (3), A. Tosetto (4), G. Palareti (5), M. Margaglione (6), G. Castaman (4), E. Rossi (3), A. Ciminello (3), L. Valdrè (5), C. Legnani (5), G. L. Tiscia (2), V. Bafunno (6), S. Carraro (1), F. Rodeghiero (4), P. Simioni (1)

(1) Department of Cardiologic, Thoracic and Vascular Sciences, 2 nd Chair of Internal Medicine, University of Padua, Padua, Italy; (2) Thrombosis & Haemostasis Unit, IRCCS ²Casa Sollievo della Sofferenza², S. Giovanni Rotondo, Foggia, Italy; (3) Department of Hematology, Catholic University, Rome, Italy; (4) Department of Hematology, San Bortolo Hospital, Vicenza, Italy; (5) Department of Angiology and Coagulation Disorders, University of Bologna, Italy; (6) Medical Genetics, University of Foggia, Foggia, Italy

Keywords

venous thromboembolism, low-molecular-weight heparin, pregnancy, Obstetric complications

Summary

Whether the administration of low-molecular-weight heparin (LMWH) during pregnancy is effective in preventing obstetric complications and pregnancy-related venous thromboembolism (VTE) in women who are carriers of factor V Leiden (FVL) and/or prothrombin variant G20210A (PTm) is controversial. This observational study investigated the possible efficacy of pharmacological treatment with LMWH ± aspirin (ASA) in pregnancy outcomes in 1,011 pregnancies of 416 women with thrombophilia (FVL and/or PTm). Most patients were chosen on the basis of previous obstetrical complications (36%), or because of familial or personal history of venous/arterial thromboembolism (28% and 18%, respectively); 74 patients (18%) were incidentally identified. The outcome was evaluated according to the type of treatment and of the period of pregnancy when the treatment was started. After adjustment for observation before and after diagnosis of thrombophilia, previous miscarriages and VTE, parity, age and centre, we observed that LMWH had a protective effect on miscarriages (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.29–0.94) and VTE (OR 0.05, 95% CI 0.01–0.21). ASA appeared to have no effect on the prevention of obstetric complications and VTE. A nested analysis performed in 116 women with two or more obstetric complications confirmed that the highest number of live births was recorded in the group under LMWH prophylaxis (OR 0.19, 95% CI 0.05–0.75). These results suggest that LMWH prophylaxis reduces the risk of obstetric complications in carriers of FVL and/or PTm, particularly in those with previous obstetric events. Furthermore, LMWH prophylaxis reduces the risk of pregnancy-related VTE.

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