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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.
MedLine Citation:
PMID:  22273731     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
D Tormene; E Grandone; V De Stefano; A Tosetto; G Palareti; M Margaglione; G Castaman; E Rossi; A Ciminello; L Valdrè; C Legnani; G L Tiscia; V Bafunno; S Carraro; F Rodeghiero; P Simioni
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-25
Journal Detail:
Title:  Thrombosis and haemostasis     Volume:  107     ISSN:  0340-6245     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7608063     Medline TA:  Thromb Haemost     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Dr. Daniela Tormene, Thromboembolism Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128 Padua (Italy), Tel.: +39 049 8218287, Fax: +39 049 8212661, E-mail: daniela.tormene@unipd.it.
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