Everything the clinician needs to know about evidence-based anticoagulation in pregnancy

Scheres, Luuk J. J.; Bistervels, Ingrid M.; Middeldorp, Saskia

doi:10.1016/j.blre.2018.08.001

Cited by 35 publications

(43 citation statements)

References 162 publications

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“…However, no clear evidence-based recommendation exists yet to clarify whether the woman's daughter should be tested in the future in case of combined oral contraceptive prescription or in case of desire for pregnancy. 20 Of note, the major limitation of this case report is that blood collection was not repeated while the proband was taking a combined oral contraceptive to assert the reproducibility of the measure. However, the biological reproducibility of the assay as well as the analytical reproducibility of ST Genesia in our laboratory is very good (see Table S3), the thrombin generation results were coherent with the presence of a combined oral contraceptive and factor V Leiden mutation, and no potential influencing factor (particularly no other medication and no recent infection) could be identified.…”

Section: Discussionmentioning

confidence: 97%

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Thrombin generation in a woman with heterozygous factor V Leiden and combined oral contraceptives: A case report

Zermatten

Calderara

Aliotta

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Combined oral contraceptives and factor V Leiden mutation are multiplicative risk factors for venous thromboembolism. However, it remains unknown whether this multiplicative effect is reflected in thrombin generation assays. We report here the evolution of the thrombin generation profile while taking combined oral contraceptives and after their discontinuation in a woman with heterozygous factor V Leiden mutation. The proband exhibited a distinctly prothrombotic thrombin generation profile including markedly decreased thrombomodulin (TM) sensitivity, compared to the control population. This profile possibly reflected a high thrombotic risk. After discontinuation of combined oral contraceptives, thrombin generation and TM sensitivity improved greatly, leaving only a slightly prothrombotic profile. Therefore, the multiplied thrombotic risk occurring with simultaneous combined oral contraceptives and factor V Leiden mutation is reflected by a thrombin generation assay performed without and with TM. This could be a promising tool to identify women taking combined oral contraceptives at high risk for venous thromboembolism. Further studies are needed to verify this hypothesis.

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Section: Discussionmentioning

confidence: 97%

“…Testing for factor V Leiden in her young children was not advised because of the absence of immediate consequences. However, no clear evidence‐based recommendation exists yet to clarify whether the woman’s daughter should be tested in the future in case of combined oral contraceptive prescription or in case of desire for pregnancy …”

Section: Discussionmentioning

confidence: 99%

Thrombin generation in a woman with heterozygous factor V Leiden and combined oral contraceptives: A case report

Zermatten

Calderara

Aliotta

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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“…One approach has been to grade the different types of thrombophilia as severe, intermediate or minor types, and to look at events in other family members with the same thrombophilic abnormality. Table 3 [13,14] summarises the recommendations by various authors. It is imperative that the total patient 'package' must be evaluated, e.g.…”

Section: Does the Patient Have A Family History (First Degree) Of Thrmentioning

confidence: 99%

Venous thromboembolism in pregnancy

Wessels

2019

S Afr Med J

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“…Treatment with anticoagulants may increase the risk of bleeding in pregnancy or around delivery. Furthermore, it is burdensome, requires daily subcutaneous injections and often causes delayed-type hypersensitivity skin reactions, itching and/or bruises [13,14]. Therefore, evidence to justify anticoagulants for women with inherited thrombophilia and recurrent miscarriage is urgently required.…”

Section: Introductionmentioning

confidence: 99%

Progress of the ALIFE2 study: A dynamic road towards more evidence

Hamulyák

Jong

Scheres

et al. 2020

Thrombosis Research

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Investigator-initiated studies are invaluable, especially in fields that are not particularly of interest for the pharmaceutical industry because they are either less profitable or concern special patient groups such as pregnant women. However, designing, conducting, and completing an investigator-initiated randomised controlled trial is challenging. Patients and physicians' preferences, ethics requirements, (international) legislation and funding are all areas where such challenges are encountered. The Anticoagulants for LIving FEtuses (ALIFE) 2 study (NTR3361) is an example of an investigator initiated international multicenter trial that progresses slowly, at least initially, as many challenges had to be overcome. Here, we discuss the challenges we faced during the course of the ALIFE2 study up till now and we explain how some of these challenges can be tackled or even avoided.

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Everything the clinician needs to know about evidence-based anticoagulation in pregnancy

Cited by 35 publications

References 162 publications

Thrombin generation in a woman with heterozygous factor V Leiden and combined oral contraceptives: A case report

Thrombin generation in a woman with heterozygous factor V Leiden and combined oral contraceptives: A case report

Venous thromboembolism in pregnancy

Progress of the ALIFE2 study: A dynamic road towards more evidence

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