Inherited thrombophilia and anticoagulant therapy for women with reproductive failure

Abstract

Reproductive failure (RF) is the inability to conceive or to carry a pregnancy to term, and its prevalence is not negligible. Pregnancy is a prothrombotic condition, which can be abnormally exaggerated in women with thrombophilia. Antiphospholipid syndrome is a cause of RF and effectively managed with heparin and aspirin. However, there are yet insufficient data in patients with RF and inherited thrombophilia. This review focuses on the significance of inherited thrombophilia and RF and the role of anticoagulants in pregnancy outcomes. A few randomized case‐control studies have investigated the effect of anticoagulation in RF with thrombophilia, and the results are yet debatable. Some inherited thrombophilia including mutations of factor V Leiden, prothrombin, and methylenetetrahydrofolate reductase and protein S deficiency are associated with RF and/or late pregnancy complications. There are several implications which influence the diagnosis and treatment. First, there is a lack of studies revealing appropriate thrombophilia markers and its cutoff values for RF specifically. Second, some thrombophilia markers change with sex and age. Lastly, the study designs of previous studies are heterogeneous in selecting the thrombophilia markers and drugs. Further studies to find adequate thrombophilia markers of RF are warranted and eventually elucidate the subgroups beneficial to anticoagulation treatment.

Association of the PECAM-1 (Leu125Val) and P-Selectin (Thr715Pro) Gene Polymorphisms With Unexplained Spontaneous Miscarriages

“…The possible involvement of PECAM-1 and P-Selectin polymorphisms in unexplained miscarriages could be of particular therapeutic interest, given that heparin is capable of binding PECAM-1 and P-Selectin attenuating mediated adhesions and, consequently, reducing the effectiveness of the inflammatory and prothrombotic response [ 24 , 25 ]. If our results are verified by larger studies, carriers of these two SNPs would be most likely to benefit from heparin treatment.…”

Predictive value of D-dimer in patients with unexplained recurrent implantation failure during freeze-thaw embryo transfer cycles

“…Interest in thrombophilia in RIF patients is largely in uenced by the clinical association between alteration of hemostasis and a trend toward a hypercoagulable state and recurrent pregnancy loss. In recent years, several researchers have found that thrombophilic single nucleotide polymorphisms and acquired thrombophilia were more prevalent in the IVF failure group [12][13]15]. A possible mechanism for URIF is thrombosis of the maternal vessels, especially the decidual or chorionic vessels, which can reduce perfusion of the intervillous space, preventing embryo implantation [16].…”

Research trends and Hotspots of Thrombophilia with recurrent pregnancy loss: a Bibliometric Analysis

“…The application of anticoagulants and immune agents was the research hotspot of APS and RPL. Aspirin or heparin or both for improving pregnancy outcomes in women with persistent antiphospholipid antibodies and RPL [29,30]. And the antimalarial hydroxychloroquine (HCQ) is currently the center of attention in thrombotic APS and is recognized as safe [27].…”

“…The assessment of women with RPL is limited at present. So, the research on the relationship between thrombophilia and RPL suggests that there could be differences in the clinical relevance of different types of thrombophilia [30]. More clinical trials and basic research are needed in the future and we should attach more attention to in-vitro fertilization.…”