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Thromb Haemost 2012; 107(03): 477-484
DOI: 10.1160/TH11-07-0470
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

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

Daniela Tormene
1   Department of Cardiologic, Thoracic and Vascular Sciences, 2nd Chair of Internal Medicine, University of Padua, Padua, Italy
,
Elvira Grandone
2   Thrombosis & Haemostasis Unit, IRCCS ″Casa Sollievo della Sofferenza″, S. Giovanni Rotondo, Foggia, Italy
,
Valerio De Stefano
3   Department of Hematology, Catholic University, Rome, Italy
,
Alberto Tosetto
4   Department of Hematology, San Bortolo Hospital, Vicenza, Italy
,
Gualtiero Palareti
5   Department of Angiology and Coagulation Disorders, University of Bologna, Italy
,
Maurizio Margaglione
6   Medical Genetics, University of Foggia, Foggia, Italy
,
Giancarlo Castaman
4   Department of Hematology, San Bortolo Hospital, Vicenza, Italy
,
Elena Rossi
3   Department of Hematology, Catholic University, Rome, Italy
,
Angela Ciminello
3   Department of Hematology, Catholic University, Rome, Italy
,
Leila Valdrè
5   Department of Angiology and Coagulation Disorders, University of Bologna, Italy
,
Cristina Legnani
5   Department of Angiology and Coagulation Disorders, University of Bologna, Italy
,
Giovanni Luca Tiscia
2   Thrombosis & Haemostasis Unit, IRCCS ″Casa Sollievo della Sofferenza″, S. Giovanni Rotondo, Foggia, Italy
,
Valeria Bafunno
6   Medical Genetics, University of Foggia, Foggia, Italy
,
Sara Carraro
1   Department of Cardiologic, Thoracic and Vascular Sciences, 2nd Chair of Internal Medicine, University of Padua, Padua, Italy
,
Francesco Rodeghiero
4   Department of Hematology, San Bortolo Hospital, Vicenza, Italy
,
Paolo Simioni
1   Department of Cardiologic, Thoracic and Vascular Sciences, 2nd Chair of Internal Medicine, University of Padua, Padua, Italy
› Author Affiliations
Further Information

Publication History

Received: 11 July 2011

Accepted after major revision: 09 January 2011

Publication Date:
29 November 2017 (online)

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Summary

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.

Keywords

Obstetric complications - venous thromboembolism - pregnancy - low-molecular-weight heparin
 

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