Preventing thrombophilia-related complications of pregnancy

Abstract

Pregnancy is associated with an increased risk of venous thromboembolism (VTE) and approximately half of all pregnancy-related VTEs are associated with thrombophilia. Recent studies suggest that there is a link between thrombophilia and other adverse pregnancy outcomes, such as fetal loss, preeclampsia, placental abruption and intrauterine growth restriction. However, the associations reported are modest, and high quality data are limited. Although the most compelling data derive from pregnant women with antiphospholipid antibodies, the use of anticoagulants for the prevention of pregnancy complications other than VTE in women with heritable thrombophilias is becoming more frequent. In this article, we review the impact of the various thrombophilias on pregnancy and its outcome, the evidence for therapies aimed at prevention of thrombophilia-related pregnancy complications, and briefly discuss the role of screening for thrombophilia in pregnancy.

Approach to Thrombophilia in Pregnancy—A Narrative Review

“…Due to probable maternal and foetal complications, a proper therapeutic strategy during pregnancy is quite demanding. Various therapeutic methods have been taken into consideration regarding the management of pregnant women diagnosed with hereditary thrombophilia, such as: anticoagulants, antiplatelets drugs and vitamins [ 6 , 42 , 49 ]. When choosing an ideal treatment for a pregnant woman with inherited thrombophilia, additional risks must be deliberated, regarding its efficacy and safety.…”

“…When inherited thrombophilia is confirmed, antepartum prophylaxis should be initiated immediately, since the risk of VTE seems to develop early in pregnancy [ 49 ]. The administration of anticoagulants during pregnancy is challenging, due to possible associated complications [ 47 ].…”

“…Vitamin K antagonists, warfarin for instance, crosses the placenta, being disclosed as potential causer for the enumerated complications—for example, it may lead to the hypoplasia of the nasal bone, if it is administrated between weeks 6 and 12 of pregnancy, or it may cause anomalies of the central nervous system in any trimester [ 47 ]. In a study conducted in vitro in 2002 [ 49 , 51 ], there was no trace of transplacental transfer of fondaparinux, which is a synthetic pentasaccharide, an antithrombotic agent that selectively inhibit coagulation factor Xa. Even though it has been described being a safe agent, it may cause foetal teratogenicity, so its usage is mainly restrictive.…”

“…APS represents an acquired form of thrombophilia, defined by the presence of antiphospholipid antibodies (aPL), clinically characterized by arterial or venous thrombosis. This is also associated with obstetric complications, the diagnosis being based on the Sydney criteria: one clinical criteria (pregnancy morbidity or arterious or venous thrombosis) and one laboratory criteria (high value of lupus anticoagulant, of anticardiolipin antibodies IgM/IgG or of anti-beta 2 glicoprotein-I antibodies IgM/IgG) [ 40 , 49 , 54 , 55 ]. Although antiphospolipid syndrome (APS) was first identified as an autoimmune thrombophilia, we now know that additional mechanisms besides coagulation-mediated thrombosis play a role in various clinical presentations; for example, complement activation may play a role in placental damage, which can result in fetal loss [ 56 ].…”

“…Although antiphospolipid syndrome (APS) was first identified as an autoimmune thrombophilia, we now know that additional mechanisms besides coagulation-mediated thrombosis play a role in various clinical presentations; for example, complement activation may play a role in placental damage, which can result in fetal loss [ 56 ]. Even though anticoagulants and thrombolytics are the most administrated drugs in order to prevent pregnancy-related complications in women diagnosed with hereditary thrombophilia ( Table 1 ) [ 54 ], at the time of delivery, the risk of haemorrhage may occur in anticoagulated women, but it can be reduced with careful preparation ( Table 2 ) [ 49 ].…”