PMID- 20034330
OWN - NLM
STAT- MEDLINE
DCOM- 20100126
LR  - 20091225
IS  - 1330-0164 (Print)
IS  - 1330-0164 (Linking)
VI  - 63
IP  - 4
DP  - 2009 Oct
TI  - [Thrombophilia, preeclampsia and other pregnancy complications].
PG  - 297-305
AB  - The aim of this paper is to present the latest developments in therapy and 
      prophylaxis of deep vein thrombosis and other pregnancy complications in women 
      with inherited or acquired thrombophilia and in women with mechanical heart 
      valves. The data presented in the paper have been extracted from the Current 
      Contents database. It is well known that the hypercoagulable state in pregnant 
      women, caused either by the physiological changes of pregnancy or by inherited 
      thrombophilia, increases the risk of venous thromboembolism (VTE), pulmonary 
      embolism (PE), preeclampsia, recurrent early and late fetal loss, intrauterine 
      growth retardation (IUGR), placental abruption, and other less probable 
      complications of pregnancy and its outcome. In women with mechanical heart 
      valves, the risk of systemic embolism is also seen to increase during pregnancy. 
      According to data analyzed, positive antiphospholipid antibodies (APLA) as well 
      as anticardiolipin antibody and lupus anticoagulant (nonspecific inhibitor) 
      positivity, homozygosity and heterozygosity for factor V Leiden mutation and 
      heterozygosity for the prothrombin G20210A variant, MTHFR C677T variant 
      homozygosity and hyperhomocysteinemia are in strong association with pregnancy 
      complications and severe pregnancy outcome. The strongest association for late 
      fetal loss was seen in women with protein S deficiency. In order to reduce such 
      risks, anticoagulation therapy is administered throughout pregnancy. The 
      antithrombotic agents available for the prevention and treatment of VTE during 
      pregnancy and pregnancy complications include unfractionated heparin (UFH), 
      low-molecular-weight heparin (LMWH) and aspirin. Vitamin K antagonists are 
      contraindicated in pregnancy. Low-dose aspirin may have a role in the prevention 
      of some pregnancy complications, although its safety in early pregnancy is 
      uncertain. LMWH and UFH are quite safe and efficacious when properly selected, 
      dosed and monitored. The efficacy and safety of LMWH have been demonstrated in 
      the prevention and treatment of VTE in pregnancy. LMWH in association with 
      aspirin administered throughout pregnancy have been shown to be associated with a 
      lower risk of complications in women with APLA syndrome. Women at a high risk of 
      preeclampsia are recommended to use low-dose aspirin throughout pregnancy. When 
      there is a history of preeclampsia, the administration of anticoagulation therapy 
      is not recommended as a prophylaxis in subsequent pregnancies, as the risk 
      appears to be already decreased as compared with previous pregnancy. LMWH has 
      probable advantages over UFH for the incidence of side effects. In pregnant women 
      with mechanical heart valves, anticoagulant therapy during pregnancy should 
      include assessment of additional risk factors for thromboembolism including valve 
      type, position, and history of thromboembolism, and decision should also be 
      strongly influenced by the patient's preferences. If the risk of thromboembolism 
      in patients with mechanical heart valves is considered very high, and efficacy or 
      safety of prophylaxis with UFH or LMWH is not satisfactory (older-generation 
      prosthesis in the mitral position or history of thromboembolism), administration 
      of vitamin K antagonists throughout pregnancy is recommended with replacement by 
      UFH or LMWH close to delivery. It should be considered that limited effectiveness 
      of UFH or LMWH in patients with mechanical heart valves might be due to 
      inadequate dosing. The necessity of anticoagulation therapy in women with 
      inherited or acquired thrombophilia is biologically plausible; nevertheless, 
      optimum management in such cases remains unknown.
FAU - Vucic, Niksa
AU  - Vucic N
AD  - Department of Hematology and Blood Coagulability Disorders, University Department 
      of Medicine, Sveti Duh General Hospital, Zagreb, Croatia.
FAU - Frleta, Marina
AU  - Frleta M
FAU - Petrovic, Davor
AU  - Petrovic D
FAU - Ostojic, Vedran
AU  - Ostojic V
LA  - hrv
PT  - English Abstract
PT  - Journal Article
PT  - Review
TT  - Trombofilija, preeklampsija i ostale komplikacije trudnoce.
PL  - Croatia
TA  - Acta Med Croatica
JT  - Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti
JID - 9208249
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Female
MH  - Fibrinolytic Agents/therapeutic use
MH  - Heart Valve Prosthesis/adverse effects
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Pre-Eclampsia/*etiology
MH  - Pregnancy
MH  - *Pregnancy Complications, Hematologic/drug therapy
MH  - Thromboembolism/prevention & control
MH  - *Thrombophilia/complications/drug therapy
RF  - 81
EDAT- 2009/12/26 06:00
MHDA- 2010/01/27 06:00
CRDT- 2009/12/26 06:00
PHST- 2009/12/26 06:00 [entrez]
PHST- 2009/12/26 06:00 [pubmed]
PHST- 2010/01/27 06:00 [medline]
PST - ppublish
SO  - Acta Med Croatica. 2009 Oct;63(4):297-305.