This chapter will review the impact of the thrombophilias on pregnancy and its outcome, evidence for therapies aimed at the prevention of thrombophilia-related pregnancy complications, and provide guidance for the prevention and management of thrombophilia-associated pregnancy complications. 2017 Oct 27;9(10):209-213. doi: 10.4240/wjgs.v9.i10.209. Vasa. Recommendations for inherited thrombophilia based on assigned risk category. While patients who develop VTE during their pregnancy should be treated in a similar manner regardless of whether or not they have an underlying thrombophilia, patients with an inherited or acquired thrombophilia but without acute clot do not necessarily merit anticoagulation. Prophylactic anticoagulation should be addressed on a case-by-case basis taking into account the inherited and acquired thrombophilias and history of prior pregnancies and their outcomes. Development of thrombosis in pregnancy is multifactorial due to the physiologic changes of pregnancy—which induce a relative hypercoagulable state—as well as physical changes leading to increased stasis and also the effects of both the inherited and the acquired thrombophilias. The odds ratio for VTE occurrence in pregnancy is 4.8 for women with protein C deficiency, 3.2 for protein S deficiency, and 4.7 for antithrombin deficiency [18]. Pregnant women have been shown to require higher doses of UFH to achieve both prophylactic and therapeutic levels of anticoagulation [44]. The use of thromboprophylaxis during pregnancy resulted in a significantly lower rate of fetal loss (0% versus 45%), but this study is also difficult to interpret since it was small and not randomized or blinded. Other thrombophilias may also be associated with preeclampsia as suggested by a recent meta-analysis which found a 12.7 odds ratio for an association with protein S deficiency and a 21.5 odds ratio for an association with protein C [31]. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This issue is not however without controversy, as it was shown in a trial in which similar rates of live births were seen in women with antiphospholipid syndrome treated with heparin and aspirin or aspirin alone, suggesting no additional benefit from heparin [60]. In this study it was found that the risk of abruption increased as the number of thrombophilic conditions carried by the patient increased in a dose dependent manner. We are committed to sharing findings related to COVID-19 as quickly as possible. Therapeutic dose LMWH requires dose adjustment during pregnancy as weight increases. -, Goldhaber SZ, Tapson VF. Although these studies have been inclusive in many of the associations between thrombophilias and poor pregnancy outcomes, many still base treatment decisions on these minimally conclusive statistical data. Thrombotic disease is a major cause of peripartum morbidity and mortality worldwide. Diagnostics (Basel). Many studies have tried to address this issue and there is still controversy regarding the importance of thrombophilia in fetal loss. Another cohort study of over 490 patients found that there was no association between maternal thrombophilia and early pregnancy loss [30]. A meta-analysis that looked at the roles of Factor V Leiden and prothrombin gene mutation as well as MTHFR homozygosis and the risk of intrauterine growth restriction did not reveal an underlying association [25]. 1997;73(1):31–36. Two meta-analyses demonstrated that the presence of the Factor V Leiden or prothrombin 20210 gene mutation was associated with increased risk of pregnancy loss in the first or second trimester as well as with recurrent pregnancy losses [18, 28]. The overall impact of the inherited and acquired thrombophilias is low in the nonpregnant population, and the majority of patients never experience a thrombotic event. In order to develop guidelines for management of women with thrombophilia and adverse pregnancy outcomes, the American College of Chest Physicians has established recommended treatment guidelines based on both family and personal history of VTE [46]. Mesenteric vein thrombosis following impregnation. 2004;93(2):259–262. Get the latest research from NIH: https://www.nih.gov/coronavirus. It has been estimated that the women who are over 35 and pregnant have a 1.38-fold increased risk of having a clotting event during the peripartum period [8]. Review articles are excluded from this waiver policy. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. The odds ratio for stillbirth for individual defects were antithrombin deficiency of 5.2, protein C of 2.3, protein S deficiency of 3.3, and Factor V Leiden 2.0. Based on all the evidence presented, it is clear that further studies are needed to address the issues around the role of anticoagulation in preventing further pregnancy loss. While all women with VTE should receive systemic treatment, the evidence supporting prophylactic anticoagulation is less clear.

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