The Role of Thrombophilia in Pregnancy

Thrombotic disease is a major cause of peripartum morbidity and mortality worldwide. Development of thrombosis in pregnancy is multifactorial due to the physiologic changes of pregnancy—which induce a relative hypercoagulable state—as well as physical changes leading to increased stasis and also the effects of both the inherited and the acquired thrombophilias. In this review, we discuss the impact of each of these factors on the development of thrombosis as well as the evidence for the impact of pregnancy-associated thrombosis on pregnancy outcome. We then discuss the use of both prophylactic and therapeutic anticoagulation during pregnancy and the puerperium. We review the indications and dosing recommendations for administration of anticoagulation in a context of discussing the evidence including the lack of evidence and formal guidelines in this area. We briefly address the role of the new oral anticoagulants in pregnancy and conclude that significant further research in women with thrombophilias and pregnancy-associated thrombosis may help clarify the management of this condition in the future.

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Abstract W P302: Assessment of a New Method of Warfarin Management vs the New Oral Anticoagulants and Conventional Warfarin Management in Atrial Fibrillation

Stroke ◽

10.1161/str.46.suppl_1.wp302 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Henry I Bussey ◽

Edith Nutescu

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulants ◽

New Oral Anticoagulants ◽

Target Range ◽

Regression Equations ◽

Major Event ◽

Cost Avoidance ◽

Study Results ◽

Event Rates ◽

The Impact

PURPOSE: To assess the impact of International Normalized Ratio (INR) self testing and online remote monitoring and management (STORM2) on clinical events and costs vs. traditional warfarin management and the new oral anticoagulants (NOACs) in atrial fibrillation (AF). METHODS: Seven STORM2 trials had a weighted mean INR time in the target range (TTR) of 77.2%. Thromboembolism (TE) and major bleeding (MB) rates at 30%, 45%, 55%, 65%, and 75% TTR were calculated using linear regression equations from a systematic review of 38 AF studies. MB = 10.104 - 0.120x[TTR], (p = 0.004) and TE = 8.313 - 0.098x[TTR], (p = 0.03). MB and TE rates were sub-divided based on the distribution in the NOAC trials. TTR-based mortality was calculated based on a 6%/yr rate multiplied by the adjusted relative risks from a data base analysis of approximately 38,000 AF patients. Projected event rates at 75% TTR, expressed as number per 1,000 patient-years, were compared to event rates at lower TTR ranges and to rates reported in the NOAC trials. Differences in major event rates were used to calculate cost avoidance. RESULTS: Projected event rates with STORM2 (TTR of 75%) when compared to “conventional ” TTR of 55% to 65% were 64% to 71% lower for MB, 47% to 64% lower for TE, and 47% to 57% lower for mortality. Compared to the NOAC study results, the projected rates were 48% to 70% lower for MB, 41% to 66% lower for TE, and 40% to 53% lower for mortality. Projected cost avoidance was $10.4 million vs. a TTR of < 30%, $2.2 million vs. a TTR of 65%; and from $1.4 to $3.1 million vs the NOACs. Costs of “other” MB and TE , drug costs, and monitoring costs were not included in the estimates. CONCLUSIONS: STORM2 management of warfarin is projected to produce a 50% or greater reduction in major event rates with a cost avoidance of $1.4 to $10.4 million per 1,000 patients per year. CLINICAL IMPLICATIONS: STORM2 management may transform the safety and efficacy of anticoagulation for the millions of people with AF while substantially reducing costs. These findings warrant randomized, prospective trials in AF and other indications for anticoagulation.

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Role of Proteases and Their Tissue Inhibitors in Pregnancy Outcome

Proteases in Health and Disease ◽

10.1007/978-1-4614-9233-7_16 ◽

2013 ◽

pp. 277-287

Author(s):

Sudhir C. Roy

Keyword(s):

Pregnancy Outcome ◽

Tissue Inhibitors ◽

In Pregnancy

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Self-concept of cervical cancer patients after chemotheraphy in Yogyakarta

Journal of Health Technology Assessment in Midwifery ◽

10.31101/jhtam.1914 ◽

2021 ◽

Vol 4 (1) ◽

pp. 37-43

Author(s):

Nur Azizah Indriastuti ◽

Riski Oktafia ◽

Novika Riswanti

Keyword(s):

Cervical Cancer ◽

Cancer Patients ◽

Qualitative Method ◽

Self Concept ◽

Social Changes ◽

The World ◽

Chemotherapy Patients ◽

Physical Changes ◽

The Impact

Cervical cancer is one of the deadliest types of cancer that attacks women in the world. One of the treatment efforts for cancer is chemotherapy. Patients with cervical cancer who receive chemotherapy more than twice will experience impaired self-concept. This study aims to determine self-concept in cervical cancer patients who have undergone chemotherapy in Yogyakarta. This research uses qualitative method with phenomenology approach. Data collection is done with interview and observation. Participants totaling five people were determined by purposive sampling. The validity of the data used source triangulation and checked the data back to the participants. Analysis of data were by comparing among categories, marking and describing descriptively. The results of the study are 6 themes, namely physical changes, emotional changes, changes in sexual relations, changes in relationships with family, changes in the role of parenting and social changes in society. The impact of chemotherapy causes various changes in cervical cancer patients which make the self-concept of cervical cancer patients undergo changes

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Research trials in the older stroke patient

Stroke in the Older Person ◽

10.1093/med/9780198747499.003.0029 ◽

2020 ◽

pp. 437-450

Author(s):

Kailash Krishnan ◽

Nikola Sprigg

Keyword(s):

Clinical Trials ◽

Older People ◽

Stroke Patient ◽

Oral Anticoagulants ◽

Intravenous Thrombolysis ◽

Lipid Lowering ◽

Good Communication ◽

Decompressive Hemicraniectomy ◽

The Impact

‘Research trials in the older stroke patient’ examines the challenges of research in older people, the phenomenon of ageism, the impact of frailty, trials of acute treatments like intravenous thrombolysis and endovascular therapy, acute lowering of blood pressure, and decompressive hemicraniectomy. Trials looking at secondary prevention, including cardioembolism, role of the newer oral anticoagulants (DOACs), carotid endarterectomy, lipid lowering, antihypertensive therapy, are examined. The broader issue of difficulties in recruiting older people to stroke trials and the potential solutions are discussed. Until recently most participants in clinical trials of stroke have been relatively young with little or no comorbidity. With a group growing more than any other, it becomes a priority to understand the challenges in recruiting and retaining older patients into clinical trials. Barriers to recruitment relate to both researchers and participants; solutions include good communication, logistical support, and innovative study design and sampling. Further research will hopefully narrow the gap to those seen in real-world clinical practice.

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The Impact of Subclinical Hypothyroidism on Adverse Perinatal Outcomes and the Role of Thyroid Screening in Pregnancy

Frontiers in Endocrinology ◽

10.3389/fendo.2019.00522 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 4

Author(s):

Mei-Qin Wu ◽

Jin Liu ◽

Ya-Qian Wang ◽

Ying Yang ◽

Chong-Huai Yan ◽

...

Keyword(s):

Subclinical Hypothyroidism ◽

Perinatal Outcomes ◽

Thyroid Screening ◽

Adverse Perinatal Outcomes ◽

The Impact ◽

In Pregnancy

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Quality Appraisal of Guidelines on Cancer-Associated Thrombosis Using AGREE II Instrument and Analysis of Current Status of New Oral Anticoagulants

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029619846562 ◽

2019 ◽

Vol 25 ◽

pp. 107602961984656 ◽

Cited By ~ 2

Author(s):

Jiuxing Zhang ◽

Juan Xu ◽

Wenlong Zhang ◽

Meiting Jiang ◽

Juan Liu ◽

...

Keyword(s):

Clinical Practice ◽

Oral Anticoagulants ◽

New Oral Anticoagulants ◽

Current Status ◽

Supporting Evidence ◽

Agree Ii ◽

Prevention And Treatment ◽

Cancer Associated Thrombosis

Cancer-associated thrombosis (CAT) studies have increased in recent years and the quality of guidelines to guide the clinical practice of CAT prevention and treatment becomes crucial. The therapy status of new oral anticoagulants (NOACs) has been established in some thrombotic diseases, but the evidence for CAT remains unconvincing. The aim of this research is to evaluate the quality of CAT guidelines and discuss the role of NOAC in CAT. A search of articles was performed using PubMed/Medline, Chinese National Knowledge Infrastructure, and other authoritative websites. Search terms included guideline or guidance, consensuses, cancer, and thrombosis. Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool was used to evaluate the qualities of the guidelines. A total of 19 guidelines were screened out and evaluated, of which 8 were recommended, 5 were recommended after revision, and 6 were not recommended. For prevention and treatment of CAT, low-molecular-weight heparin is the most recommended, followed by vitamin K antagonist, unfractionated heparin, fondaparinux, and aspirin. New oral anticoagulant is optional in some cases of CAT treatment. Based on AGREE II assessment tool, the quality of CAT guidelines is inconsistent. Attention should be drawn to the quality of CAT guidelines during clinical practice. The role of NOAC in the treatment of CAT is gradually established but requires more supporting evidence from future clinical trials.

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