Inherited and acquired thrombophilias and poor pregnancy outcome: Should we be treating with heparin?
Date
2003, 2003
Authors
Gebhardt G.S.
Hall D.R.
Gebhardt G.S.
Hall D.R.
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Purpose of review: The most important acquired thrombophilia related to poor pregnancy outcome is probably antiphospholipid syndrome. Inherited thrombophilias that have been implicated in venous thromboembolism and poor pregnancy outcome and for which standard tests are generally available are antithrombin III deficiency, the factor V Leiden mutation, prothrombin G20210A mutation and the C677T polymorphism in the methylenetetrahydrofolate reductase system implicated in mild hyperhomocysteinaemia. The management of antiphospholipid syndrome with previous fetal losses is well documented and substantiated by small clinical trials. It is the purpose of this review to investigate new contributions to this field since June 2002. Recent findings: Only one randomized trial was published during the review period, but a Cochrane review and several excellent review articles appeared detailing management. Summary: There is a dire lack of randomized trials in the literature on the efficacy of heparin or other coagulation modulators on pregnancy outcome in patients with inherited thrombophilias. There is consensus on thrombo-prophylaxis for antiphospholipid syndrome. Protocols for the management of venous thromboembolism and pulmonary emboli related to pregnancy are well established. © 2003 Lippincott Williams & Wilkins.
Purpose of review: The most important acquired thrombophilia related to poor pregnancy outcome is probably antiphospholipid syndrome. Inherited thrombophilias that have been implicated in venous thromboembolism and poor pregnancy outcome and for which standard tests are generally available are antithrombin III deficiency, the factor V Leiden mutation, prothrombin G20210A mutation and the C677T polymorphism in the methylenetetrahydrofolate reductase system implicated in mild hyperhomocysteinaemia. The management of antiphospholipid syndrome with previous fetal losses is well documented and substantiated by small clinical trials. It is the purpose of this review to investigate new contributions to this field since June 2002. Recent findings: Only one randomized trial was published during the review period, but a Cochrane review and several excellent review articles appeared detailing management. Summary: There is a dire lack of randomized trials in the literature on the efficacy of heparin or other coagulation modulators on pregnancy outcome in patients with inherited thrombophilias. There is consensus on thrombo-prophylaxis for antiphospholipid syndrome. Protocols for the management of venous thromboembolism and pulmonary emboli related to pregnancy are well established. © 2003 Lippincott Williams & Wilkins.
Purpose of review: The most important acquired thrombophilia related to poor pregnancy outcome is probably antiphospholipid syndrome. Inherited thrombophilias that have been implicated in venous thromboembolism and poor pregnancy outcome and for which standard tests are generally available are antithrombin III deficiency, the factor V Leiden mutation, prothrombin G20210A mutation and the C677T polymorphism in the methylenetetrahydrofolate reductase system implicated in mild hyperhomocysteinaemia. The management of antiphospholipid syndrome with previous fetal losses is well documented and substantiated by small clinical trials. It is the purpose of this review to investigate new contributions to this field since June 2002. Recent findings: Only one randomized trial was published during the review period, but a Cochrane review and several excellent review articles appeared detailing management. Summary: There is a dire lack of randomized trials in the literature on the efficacy of heparin or other coagulation modulators on pregnancy outcome in patients with inherited thrombophilias. There is consensus on thrombo-prophylaxis for antiphospholipid syndrome. Protocols for the management of venous thromboembolism and pulmonary emboli related to pregnancy are well established. © 2003 Lippincott Williams & Wilkins.
Description
Keywords
acetylsalicylic acid; anticoagulant agent; antithrombin III; blood clotting factor 5 Leiden; cardiolipin antibody; heparin; homocysteine; immunoglobulin G; low molecular weight heparin; lupus anticoagulant; phospholipid antibody; protein C; protein S; prothrombin; amino acid metabolism; anticoagulant therapy; anticoagulation; antiphospholipid syndrome; antithrombin III deficiency; clinical trial; controlled clinical trial; disease association; drug dose regimen; drug efficacy; drug indication; gene mutation; genetic disorder; human; hyperhomocysteinemia; immunoglobulin blood level; intrauterine growth retardation; low drug dose; lung embolism; meta analysis; outcomes research; preeclampsia; pregnancy complication; priority journal; randomized controlled trial; review; risk assessment; risk factor; risk reduction; single nucleotide polymorphism; solutio placentae; thrombophilia; thrombosis prevention; venous thromboembolism; Anticoagulants; Antiphospholipid Syndrome; Female; Heparin; Humans; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Outcome; Thrombophilia, acetylsalicylic acid, anticoagulant agent, antithrombin III, blood clotting factor 5 Leiden, cardiolipin antibody, heparin, homocysteine, immunoglobulin G, low molecular weight heparin, lupus anticoagulant, phospholipid antibody, protein C, protein S, prothrombin, amino acid metabolism, anticoagulant therapy, anticoagulation, antiphospholipid syndrome, antithrombin III deficiency, clinical trial, controlled clinical trial, disease association, drug dose regimen, drug efficacy, drug indication, gene mutation, genetic disorder, human, hyperhomocysteinemia, immunoglobulin blood level, intrauterine growth retardation, low drug dose, lung embolism, meta analysis, outcomes research, preeclampsia, pregnancy complication, priority journal, randomized controlled trial, review, risk assessment, risk factor, risk reduction, single nucleotide polymorphism, solutio placentae, thrombophilia, thrombosis prevention, venous thromboembolism, Anticoagulants, Antiphospholipid Syndrome, Female, Heparin, Humans, Pregnancy, Pregnancy Complications, Hematologic, Pregnancy Outcome, Thrombophilia
Citation
Current Opinion in Obstetrics and Gynecology
15
6
Current Opinion in Obstetrics and Gynecology
15
6
15
6
Current Opinion in Obstetrics and Gynecology
15
6