Thromboprophylaxis in pregnant women with thrombophilia and a history of thrombosis

2018 ◽  
Vol 46 (8) ◽  
pp. 893-899 ◽  
Author(s):  
Svetlana Akinshina ◽  
Alexander Makatsariya ◽  
Victoria Bitsadze ◽  
Jamilya Khizroeva ◽  
Nadine Khamani
Keyword(s):  
Fetal Loss ◽  
Obstetric Complications ◽  
Trophoblast Invasion ◽  
Prothrombin G20210a ◽  
Factor V ◽  
Septic Complications ◽  
Group I ◽  
History Of ◽  
Thrombotic Complications ◽  
Group Ii

Abstract Background Despite intensive research, thromboembolism still accounts for significant maternal morbidity and mortality. We examined thrombophilia in patients with thromboembolism during pregnancy and evaluated the efficiency of antithrombotic prophylaxis in patients with thrombophilia for the prevention of recurrent thromboembolism. Materials and methods Sixty-eight women with a history of thromboembolism were managed during pregnancy, in light of their thrombotic history and the result of thrombophilia assessment. Group I (n=50) received prophylaxis with low molecular weight heparin (LMWH)±aspirin (50–100 mg/day) in preconception period or from the 1st trimester, during pregnancy and at least 6 weeks postpartum. Group II (n=18) received LMWH±aspirin from the II to III trimester. Results Thromboses were associated with pregnancy in 27 patients (39.7%), with systemic diseases – in nine (13.2%), oral contraceptives use – 22 (32.3%), immobilization due to surgery and/or trauma, long flight – six (8.9%), septic complications – two (2.9%). Nevertheless, 24.5% of patients had no apparent provoking factor for the development of thrombotic complications. Thirty-seven (54%) patients with venous thromboembolism (VTE) had familial history of VTE, and 25 (36.7%) had personal history of pregnancy complications (fetal loss syndrome, preeclampsia and placental abruption) (P<0.05 vs. control). Thrombophilia was detected in 58 (85.3%). Usual thrombogenic polymorphisms [factor V (FV) Leiden and prothrombin G20210A, heterozygous forms] were revealed in 16 (23.5%) and eight (11.7%) patients, respectively. Antiphospholipid antibodies (aPL) circulation was found in 34 (50%) patients. Non-usual thrombogenic polymorphisms were identified in 44 (64.7%) of the women and hyperhomocysteinemia – in 30 (44.2%). In group I no one had severe obstetric complications. All the patients were delivered at term and all the babies were alive. In group II moderate-to-severe obstetric complications were noted: preeclampsia – in 11 (16.2%), severe preeclampsia – seven (10.3%), preterm delivery – in 18 (26.4%) patients from subgroup II (P<0.05). Conclusions Women with a personal or a family history of thromboembolism and obstetric complications should be screened for thrombophilia. Beginning anticoagulant therapy early in such patients is effective not only for preventing recurring thrombosis but also preventing obstetric complications. Late prophylaxis after the completion of the trophoblast invasion therapy is much less effective.

Factor V Leiden Is Associated with Repeated and Recurrent Unexplained Fetal Losses

1997 ◽  
Vol 77 (05) ◽  
pp. 0822-0824 ◽  
Author(s):  
Elvira Grandone ◽  
Maurizio Margaglione ◽  
Donatella Colaizzo ◽  
Marina d'Addedda ◽  
Giuseppe Cappucci ◽  
...  
Keyword(s):  
Protein C ◽  
Strong Association ◽  
Activated Protein C ◽  
Fetal Loss ◽  
Factor V Leiden ◽  
Factor V ◽  
Significant Difference ◽  
History Of ◽  
Fv Leiden ◽  
Caucasian Women

SummaryActivated protein C resistance (APCR) is responsible for most cases of familial thrombosis. The factor V missense mutation Arg506>Gln (FV Leiden) has been recognized as the commonest cause of this condition. Recently, it has been suggested that APCR is associated with second trimester fetal loss. We investigated the distribution of FV Leiden in a sample (n = 43) of Caucasian women with a history of two or more unexplained fetal losses. A group (n = 118) of parous women with uneventful pregnancies from the same ethnical background served as control. We found the mutation in 7 cases (16.28%) and 5 controls (4.24%; p = 0.011). A statistically significant difference between women with only early fetal loss vs those with late events (p = 0.04) was observed. Our data demonstrate a strong association between FV Leiden and fetal loss. Furthermore, they indicate that late events are more common in these patients.

scholarly journals TO STUDY THE ONSET AND PROGRESSION OF AIRWAY ABNORMALITY IN TERMS OF ALTERATION IN PFT IN ASYMPTOMATIC SMOKERS.

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Dr. Hitesh Kumar Solanki ◽  
Dr. Omnath P Yadav ◽  
Dr. Anita J Gojiya
Keyword(s):  
Lung Function ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Medical College ◽  
Group I ◽  
Significant Difference ◽  
History Of ◽  
Young Smokers ◽  
The Mean ◽  
Group Ii

The study was conducted in department of physiology, B J Medical College, Ahmedabad from Mar. 2012 to Feb. 2013. This was a cross-sectional study to evaluate the effect of smoking on lung   function and serum lipids in asymptomatic smokers   and comparable non   smokers. The mean of the various spirometric parameters were calculated of the subjects for both the groups. The mean FVC in group I and group II was 2.60 ± 0.62 L and 4.10 ± 0.64L respectively. The mean FEV1 in group I was 1.91 ± 0.57L and     3.19 ± 0.77L in group II Group I had mean FEF25% - 75% and PEFR of 1.98 ± 0.67L/sec and 4.50 ± 1.57L/sec respectively. Group II had mean FEF25 – 75% of 4.22 ± 1.23L/sec and a mean PEFR of 7.22 ± 1.42L/sec. In young smokers and asymptomatic, still the spirometric values were significantly deranged as compared to controls. Even smokers with history of less pack years of smoking also had significant abnormalities of lung function. All he spirometric values in the two groups had statistically highly significant difference and were higher in non-smokers as compared to smokers. The spirometric values were reduced in smokers with history of smoking for as low as two pack years. Keywords: Progression, PFT, Asymptomatic & Smokers

The Association Between Parameters of Erythrocytes Morphology and Thrombophilia-Related Mutations

2021 ◽  
Vol 16 ◽  
Author(s):  
Ozlem Oz ◽  
Ataman Gonel
Keyword(s):  
Factor V Leiden ◽  
Mthfr C677t ◽  
Prothrombin G20210a ◽  
Factor V ◽  
Cross Sectional ◽  
Factor V Leiden Mutation ◽  
Erythrocyte Morphology ◽  
Mthfr A1298c ◽  
G20210a Mutation ◽  
History Of

Background: Alterations in erythrocyte morphology parameters have been identified and associated with hematological disorders and other chronic and cardiovascular diseases. Erythrocytes are abundant in thrombus content. Their hemoglobin density and differences in the ratio of macrocytic and microcytic cells may be associated with hypercoagulopathy in those with a history of thrombosis. Objective: This cross-sectional study aimed to investigate the relationship between hemogram parameters and thrombophilia genetic parameters. Method: A total of 55 patients whose thrombophilia panel was reviewed due to the diagnosis of thrombosis were included in the study. %MIC, %MAC, %HPO, %HPR and all hemogram parameters were measured using Abbott Alinity HQ. Prothrombin G20210A, MTHFR C677T, MTHFR A1298C, Factor V Leiden G169A and PAI-1 4G/5G mutations were studied using Real Time-PCR. Results: The MTHFR C677T mutation was detected in 58.2% of the patients. The Factor V Leiden mutation was detected in 5.5% of the patients. The MTHFR A1298C mutation was detected in 58.2%, The PAI mutation was detected in 74.5%, and the Factor 13 mutation was detected in 29% of the patients. Prothrombin G20210A mutation was not detected in any of the patients. Red blood cell (RBC) and Hct values were higher in Factor 13 mutant group; the Hgb and Htc values were higher in the MTHFR C677T mutant group. Conclusion: The MTHFR C677T and Factor 13 mutations may be associated with high Hct and RBC, Hgb, and Htc values, respectively and coagulation tendency in patients with a history of thrombosis.

Risk of Pregnancy-Associated Venous Thromboembolism in Women with a History of Prior Thrombosis.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1493-1493 ◽  
Author(s):  
Andrea Gerhardt ◽  
Rudiger E. Scharf ◽  
Rainer B. Zotz
Keyword(s):  
Risk Factor ◽  
Venous Thromboembolism ◽  
Gene Mutation ◽  
Factor V Leiden ◽  
Prothrombin G20210a ◽  
Factor V ◽  
Previous Episode ◽  
Recurrent Venous Thromboembolism ◽  
History Of ◽  
Heparin Prophylaxis

Abstract Background: Previous estimates of the rate of recurrent venous thromboembolism (VTE) during pregnancy in women with a history of VTE have vary between 0 and 13%. Therefore, the decision to administer or withhold heparin - especially in the antepartum period - has been discussed controversial. In a recent study by Brill-Edwards et al. (N Engl J Med2000;343:1439–44), no recurrences of VTE occurred in women (n=44) who had a previous episode of thrombosis that was associated with a temporary risk factor and who also had no evidence of thrombophilia. Based on these results, antepartum heparin prophylaxis is not routinely recommended in women without thrombophilia whose previous episode of thrombosis was associated with a temporary risk factor (ACCP guidelines 2004). The objective of our study was to evaluate the risk of recurrent pregnancy-associated thrombosis in women with a history of VTE. Materials and Methods: We retrospectively studied 198 women with at least one pregnancy (275 pregnancies in total) after a one previous episode of VTE. Sixty-three women (81 pregnancies) were excluded from the analysis because of antepartum heparin prophylaxis. Results: In the subgroup of women without heparin prophylaxis (n=135), 15 (7.7%) thromboembolic events occurred antepartum in 194 pregnancies. Further subgroup analysis, stratified for the nature of first VTE, gave the following number of antepartum VTE per number of pregnancies: 2 VTE/19 pregnancies (10.5%) in 14 women (first VTE: immobilization), 4 VTE/33 pregnancies (12.1%) in 24 women (first VTE: surgery), 5 VTE/69 pregnancies (7.2%) in 46 women (first VTE: oral contraception), 2 VTE/58 pregnancies (3.4%) in 40 women (first VTE: pregnancy), 2 VTE/15 pregnancies (13%) in 11 women (first VTE: idiopathic). Nine of the 15 women with VTE (7/13 women with first VTE triggered by temporary risk factor; 2/2 women with first idiopathic VTE) had a heterozygous factor V Leiden G1691A or prothrombin G20210A gene mutation. In the postpartum period, 16 VTE in 194 pregnancies occurred after live birth in the 135 women without heparin prophylaxis. Nine of these 16 women had a heterozygous FVL or prothrombin G20210A gene mutation. In Conclusion, the risk of recurrent antepartum VTE was similar in women with and without factor V Leiden G1691A or the prothrombin G20210A gene mutation and did not differ between women with first VTE triggered by a transient risk factor or an idiopathic first VTE. In addition to recommended postpartum heparin prophylaxis, our data support the need for a routine antepartum prophylaxis in women without thrombophilia whose previous episode of thrombosis was associated with a temporary risk factor.

Incidence of Post-Thrombotic Syndrome Following Asymptomatic Thrombosis in Survivors of Childhood Acute Lymphoblastic Leukemia.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1631-1631
Author(s):  
Stefan Kuhle ◽  
Maria Spavour ◽  
Jacqueline Halton ◽  
Patricia Massicotte ◽  
Irene Cherrick ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Group I ◽  
Arm Circumference ◽  
History Of ◽  
Group Ii

Abstract BACKGROUND: Asymptomatic deep venous thrombosis (DVT) are well-known complications of treatment of acute lymphoblastic leukemia (ALL) in children. However, the clinical significance of radiographically detected, asymptomatic DVT is unclear and controversial, as there are no studies on long-term outcome of asymptomatic DVT in children available. There are two likely reasons for the studies not being done in this area. First, there is a lack of defined cohorts of pediatric patients screened for DVT and secondly, there is a great deal of difficulty in following patients over many years. The study, Prophylaxis with Antithrombin Replacement in Kids with ALL treated with L-Asparaginase (PARKAA) was a multicentre randomized controlled trial in which children with ALL were screened for DVT. As survivors of childhood cancer, the PARKAA cohort continues to be followed in their respective centers. Therefore, establishment of the PARKAA cohort (1997–99) and the ability to locate these patients provided a unique opportunity to study the long-term outcome of asymptomatic DVT. OBJECTIVE: To assess the incidence of PTS in children with ALL who previously had an asymptomatic DVT. The objective were approached in two ways. Firstly, to assess the outcome of asymptomatic DVT by determining the prevalence of PTS in children with a history of ALL with radiographically diagnosed DVT (PARKAA cohort); secondly, to corroborate the findings by determining the prevalence of PTS in an unselected group of survivors of childhood ALL. METHODS: Cross-sectional study in two separate populations: Group I comprised of children enrolled in the PARKAA multicentre study who had been screened for, and diagnosed with, DVT in the upper venous system. Group II consisted of non-selected patients &lt; 21 years with a history of ALL followed at Stollery Children’s Hospital, Edmonton. Patients were invited for a follow-up at their treatment centre (Group I) or were assessed for PTS childhood cancer survivor clinic (Group II). PTS was assessed by two of the investigators (Group I) or by the attending oncologist (Group II), respectively, using a standardized scoring sheet. RESULTS: Group I: 13 PARKAA patients with a history of ALL and objectively diagnosed DVT were assessed for PTS (4 males; median age 11.9 years; median age at diagnosis of ALL 4.4 years). 7/13 patients had PTS (54%, 95%CI 25;81). All patients with PTS had collaterals on examination, 3 also had increased arm circumference. Group II: 41 patients with a history of ALL were enrolled (61% males; median age at diagnosis 3.0 years; 28% high-risk, 67% standard risk). Mean length of follow-up since diagnosis was 9.5 years. PTS was diagnosed in 10/41 (24%; 95%CI 11–38) patients. All patients with PTS had collaterals on examination, 5 (50%) also had increased arm circumference. CONCLUSIONS: There is a clinically significant prevalence of PTS in children with a history of ALL and radiographically diagnosed DVT. A significant proportion of survivors of ALL develop PTS, indicating previously undiagnosed DVT in this population.

Primary Thrombophilia in Mexico XII: Miscarriages Are More Frequent in Persons with the Sticky Platelet Syndrome (SPS)

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4937-4937
Author(s):  
Guillermo J Ruiz-Delgado ◽  
Yahveth Cantero-Fortiz ◽  
Mariana Méndez-Huerta ◽  
Mónica León-González ◽  
Andrés A. León-Peña ◽  
...  
Keyword(s):  
General Population ◽  
Venous Thrombosis ◽  
Conflicts Of Interest ◽  
Fetal Loss ◽  
Obstetric Complications ◽  
Obstetric Outcomes ◽  
Single Institution ◽  
Clinical Marker ◽  
Female Patients ◽  
History Of

Abstract Background: The sticky platelet syndrome (SPS) is an inherited condition which leads into arterial and venous thrombosis. There is scant information about the association between the SPS and obstetric complications. Objective: To assess the relationship of the SPS and fetal loss in a single institution. Material and methods: The obstetric history of all the consecutive female patients prospectively studied along a 324 month period, in a single institution with a history of thrombosis and a clinical marker of primary thrombophilia was reviewed. Results: Between 1989 and 2016, 268 consecutive patients with a clinical marker of primary thrombophilia and a history of arterial or venous thrombosis were studied; of these, 108 were female patients. Within this subset, 77 (71%) had been pregnant at some moment. Twenty eight of these 77 patients (37%) had had an abortion and 24 out of these (86%) were found to have the SPS. On the other hand, in a subset of 73 female patients with the SPS who had been pregnant, 32% had miscarriages (14 had one abortion, 5 two abortions and 4 three or more abortions). These figures are significantly higher than the prevalence of abortions in the Mexican general population of pregnant women, which is 12-13% (chi square = 7.47; p = 0.0063). Accordingly, the relative risk of having a miscarriage is 2.66 times higher in female patients with the SPS than in the general population (p = 0.0014 ). Conclusion: In México, female patients with the SPS experience significantly more miscarriages than the general population. Since the treatment of the SPS is simple and effective and could in turn prevent adverse obstetric outcomes, its investigation in women studied because obstetric complications may be useful and deserves further research. Disclosures No relevant conflicts of interest to declare.

scholarly journals Evolutionary History of the GH3 Family Based on 48 Sequenced Plants and Identification of Jasmonic Acid-Relate GH3 Genes in Solanum tuberosum

2018 ◽  
Author(s):  
Chao Zhang ◽  
Leilei Zhang ◽  
Dongdong Wang ◽  
Haoli Ma ◽  
Bailin Liu ◽  
...  
Keyword(s):  
Solanum Tuberosum ◽  
Evolutionary History ◽  
Group Iii ◽  
Biotic Stresses ◽  
Conserved Sequence ◽  
Group I ◽  
Meja Treatment ◽  
History Of ◽  
Group Ii ◽  
Family Based

Glycoside Hydrolase 3 (GH3) is a phytohormone-responsive family of genes that has been found in many plant species. It is implicated in the biological activity of indolacetic (IAA) and jasmonic acids (JA), and also affects plant growth and developmental processes and some stresses. In this study, GH3 genes were identified in 48 plants, which belong to algae, moss, fern, gymnosperm and angiosperm. No GH3 representative gene has been found in algae, and our research identified 4 genes in mosses, 19 in ferns, 7 in gymnosperms, and numerous in Angiosperms. The results showed that GH3 genes mainly occur in seed plants. Phylogenetic analysis of all GH3 genes showed three separate clades. Group I was related to JA adenylation, group II was related to IAA adenylation, and group III was separated from group II but the function was not clear. The structure of GH3 protein indicated highly conserved sequence in the plant kingdom. The analysis of JA-adenylation related to gene expression of GH3 in potato (Solanum tuberosum) showed that StGH3.12 highly responded to Methyl Jasmonate (MeJA) treatment. Expression levels of StGH3.1, StGH3.11, and StGH3.12 were high in flower and StGH3.11 expression was also high in stolon. Our research revealed the evolution of the GH3 family, which is useful for studying the precise function about JA-adenylation GH3 genes in S. tuberosum under development and biotic stresses.

scholarly journals EVALUATION OF PUNCTURE DRAINING INTERVENTIONS EFFICACY IN PATIENTS WITH PANCREATIC FLUID COLLECTIONS

2020 ◽  
Vol 24 (3-4) ◽  
pp. 3-5
Author(s):  
Ohanezian Aikanush
Keyword(s):  
Ultrasound Guidance ◽  
Minimal Invasive ◽  
Ultrasound Guided ◽  
Septic Complications ◽  
Surgical Interventions ◽  
Group I ◽  
Specific Sign ◽  
Group Ii ◽  
Ultrasound Guided Puncture ◽  
Guided Puncture

The aim of the research is to evaluate the effectiveness of ultrasound guided punctures and drainage for FCs in AP. The results of the examination and treatment of 72 patients with FCs in AP who have been treated using step up approach in the period from 2010 till 2018 are analyzed. Patients were divided on two groups: The first group included 40 patients, who underwent draining of FCs under ultrasound guidance as a first stage of treatment. The second group included 32 patients, who underwent puncture of FCs under ultrasound guidance as the first stage of treatment. In the majority of patients in Group I (65.0%) we observed acute post-necrotic FCs. In 30 (75.0%) patients draining under ultrasound guidance was final in treatment. 10 (25.0%) patients with infected acute postnecrotic FCs, after drainage and aspiration underwent necrectomy. In most of patients of group II (62.5%) were noted acute postnecrotic FCs too. 17 patients underwent ultrasound guided puncture and aspiration of FCs. 15 patients of group II underwent drainage of acute post-necrotic FCs under the ultrasound guidance. In 11 (73.3%) of them the drainage of FCs was definitive in treatment, 4 (26.7%) - required the necrosectomy. In group II, in 81.2% patients minimal invasive surgical interventions were effective. SIRS was noted as in patients with aseptic FCs so in patients with infected FCs. In patients with acute pancreatitis, the duration of the disease up to 4 weeks, as well as the presence of SIRS, is not a specific sign of infection only. Ultrasound-guided diagnostic puncture of FCs is a safe method that facilitates early diagnosis of infected FCs. Ultrasound guided puncture with aspiration can reduce the incidence of purulent-septic complications and be definitive in treatment for aseptic acute parapancreatic FCs and aseptic acute post-necrotic FCs. Infected FCs without suppuration do not require routine drainage. Drainage is absolutely indicated in case of purulent content and persistent SIRS in patients after primary puncture of infected FCs.

scholarly journals Duplex sonography study in schistosomiasis portal hypertension: characterization of patients with and without a history of variceal bleeding

2008 ◽  
Vol 45 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Severino Marcos Borba de Arruda ◽  
Victorino Spinelli Toscano Barreto ◽  
Fernando José do Amaral
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Variceal Bleeding ◽  
Collateral Circulation ◽  
Past History ◽  
Duplex Sonography ◽  
Group I ◽  
History Of ◽  
Group Ii ◽  
Upper Gastrointestinal

BACKGROUND: Presinusoidal portal hypertension with frequent episodes of upper gastrointestinal variceal bleeding are hallmarks of hepatosplenic Manson’s schistosomiasis; a clinical form that affects about 5% of Brazilians who are infected by Schistosoma mansoni. AIMS: To evaluate duplex sonography findings in patients with hepatosplenic Manson’s schistosomiasis with and without upper gastrointestinal variceal hemorrhage. METHODS: A cross-sectional study was performed whereby 27 consecutive patients with hepatosplenic Manson’s schistosomiasis were divided into two groups: group I (six men and six women; mean age 48.7 years) with a past history of bleeding and group II (four men and eight women; mean age 44.7 years) without a past history of upper gastrointestinal bleeding, underwent duplex sonography examination. All patients underwent the same upper gastrointestinal endoscopy and laboratory examinations. Those with signs of mixed chronic liver disease or portal vein thrombosis (three cases) were excluded. RESULTS: Group I showed significantly higher mean portal vein flow velocity than group II (26.36 cm/s vs 17.15 cm/sec). Although, as a whole it was not significant in all forms of collateral vessels (83% vs 100%), there was a significantly higher frequency of splenorenal collateral circulation type in group II compared with group I (17% vs 67%). The congestion index of the portal vein was significantly lower in group I than in group II (0.057 cm vs 0.073 cm/sec). CONCLUSION: Our duplex sonography findings in hepatosplenic Manson’s schistosomiasis support the idea that schistosomotic portal hypertension is strongly influenced by overflow status, and that collateral circulation seems to play an important role in hemodynamic behavior.

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