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; Elvira Grandone; Valerio De Stefano; Alberto Tosetto; Gualtiero Palareti; Maurizio Margaglione; Giancarlo Castaman; Elena Rossi; Angela Ciminello; Leila Valdrè; Cristina Legnani; Giovanni Luca Tiscia; Valeria Bafunno; Sara Carraro; Francesco Rodeghiero; Paolo Simioni

doi:10.1160/TH11-07-0470

Thrombosis and Haemostasis, Table of Contents

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

Authors

Daniela Tormene

¹Department of Cardiologic, Thoracic and Vascular Sciences, 2nd Chair of Internal Medicine, University of Padua, Padua, Italy
Elvira Grandone

²Thrombosis & Haemostasis Unit, IRCCS ″Casa Sollievo della Sofferenza″, S. Giovanni Rotondo, Foggia, Italy
Valerio De Stefano

³Department of Hematology, Catholic University, Rome, Italy
Alberto Tosetto

⁴Department of Hematology, San Bortolo Hospital, Vicenza, Italy
Gualtiero Palareti

⁵Department of Angiology and Coagulation Disorders, University of Bologna, Italy
Maurizio Margaglione

⁶Medical Genetics, University of Foggia, Foggia, Italy
Giancarlo Castaman

⁴Department of Hematology, San Bortolo Hospital, Vicenza, Italy
Elena Rossi

³Department of Hematology, Catholic University, Rome, Italy
Angela Ciminello

³Department of Hematology, Catholic University, Rome, Italy
Leila Valdrè

⁵Department of Angiology and Coagulation Disorders, University of Bologna, Italy
Cristina Legnani

⁵Department of Angiology and Coagulation Disorders, University of Bologna, Italy
Giovanni Luca Tiscia

²Thrombosis & Haemostasis Unit, IRCCS ″Casa Sollievo della Sofferenza″, S. Giovanni Rotondo, Foggia, Italy
Valeria Bafunno

⁶Medical Genetics, University of Foggia, Foggia, Italy
Sara Carraro

¹Department of Cardiologic, Thoracic and Vascular Sciences, 2nd Chair of Internal Medicine, University of Padua, Padua, Italy
Francesco Rodeghiero

⁴Department of Hematology, San Bortolo Hospital, Vicenza, Italy
Paolo Simioni

¹Department of Cardiologic, Thoracic and Vascular Sciences, 2nd Chair of Internal Medicine, University of Padua, Padua, Italy

Abstract

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

Full Text

References

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