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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.
- Source :
-
Thrombosis and haemostasis [Thromb Haemost] 2012 Mar; Vol. 107 (3), pp. 477-84. Date of Electronic Publication: 2012 Jan 25. - Publication Year :
- 2012
-
Abstract
- 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.
- Subjects :
- Abortion, Spontaneous etiology
Abortion, Spontaneous genetics
Abortion, Spontaneous physiopathology
Adult
Aspirin administration & dosage
Aspirin adverse effects
Case-Control Studies
Drug Therapy, Combination
Factor V genetics
Female
Genetic Predisposition to Disease
Genetic Variation
Heparin, Low-Molecular-Weight adverse effects
Humans
Middle Aged
Mutation genetics
Pregnancy
Pregnancy Complications genetics
Pregnancy Complications physiopathology
Prothrombin genetics
Venous Thromboembolism complications
Venous Thromboembolism genetics
Venous Thromboembolism physiopathology
Young Adult
Abortion, Spontaneous prevention & control
Heparin, Low-Molecular-Weight administration & dosage
Pregnancy Complications drug therapy
Prothrombin metabolism
Venous Thromboembolism drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 2567-689X
- Volume :
- 107
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Thrombosis and haemostasis
- Publication Type :
- Academic Journal
- Accession number :
- 22273731
- Full Text :
- https://doi.org/10.1160/TH11-07-0470