scholarly journals Management of myelofibrosis during pregnancy: A case report

2015 ◽  
Vol 72 (4) ◽  
pp. 383-385 ◽  
Author(s):  
Radmila Zivkovic ◽  
Olivera Markovic ◽  
Dragomir Marisavljevic ◽  
Tatjana Terzic ◽  
Ljiljana Tukic
Keyword(s):  
Case Report ◽  
Myeloproliferative Neoplasm ◽  
Primary Myelofibrosis ◽  
Normal Pregnancy ◽  
Hematologic Malignancies ◽  
Low Molecular Weight ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Pregnancy And Delivery ◽  
Normal Baby

Introduction. Primary myelofibrosis (PMF) is a clonal myeloproliferative neoplasm that occurs most commonly in the decade six of life and it is very rare in the young persons. Case report. We reported a 28-year-old female patient with primary myelofibrosis who had a normal pregnancy and delivery in the week 40 of pregnancy without any complications. Two years before the diagnosis of PMF she had normal pregnancy. The patient was treated with interferon-alpha and low dose aspirin during the whole pregnancy and with low-molecular-weight heparin a week before delivery and 6 weeks after. The patient had no complications during pregnancy. She delivered in term with healthy, normal baby weight. Conclusion. Decision about treatment strategy of pregnancy associated hematologic malignancies should be made for each patient individually.

scholarly journals Ulipristal Acetate in Myomectomy Optimization in an Infertile Patient with Giant Myomas

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Elena de la Fuente ◽  
María Dolores Borrás ◽  
Miriam Rubio ◽  
Nuria Abril
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Normal Pregnancy ◽  
Uterine Wall ◽  
Surgical Removal ◽  
Preoperative Treatment ◽  
Ulipristal Acetate ◽  
Infertile Patient ◽  
Beneficial Effects ◽  
Pregnancy And Delivery

The use of ulipristal acetate (UPA) has been recently introduced in the treatment of uterine leiomyomas. This drug has proven useful to control menometrorrhagia and to reduce myoma size. In the case presented here, we show the benefits of UPA treatment in facilitating surgical removal of giant myomas in an infertile patient. In addition to myoma reduction and a better control of preoperative bleeding, the treatment with UPA reduced the duration and complexity of the surgery, as well as the area of uterine wall involved and the resulting scar. No side effects were observed and the patient became pregnant 6 months after the surgery and had a normal pregnancy and delivery. This case report shows the beneficial effects of UPA in the preoperative treatment of myomas which affect uterus function.

scholarly journals Comparative study of low dose aspirin versus combination of low dose aspirin and low molecular weight heparin in idiopathic recurrent pregnancy loss

2020 ◽  
Vol 9 (2) ◽  
pp. 512
Author(s):  
S. Bhanu Rekha ◽  
K. Sharath Chandra
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Low Dose ◽  
Recurrent Pregnancy Loss ◽  
Live Birth Rate ◽  
Low Molecular Weight ◽  
Dose Aspirin ◽  
Low Dose Aspirin

Background: To compare the role of low dose aspirin versus combination of low dose aspirin and low molecular weight heparin in idiopathic recurrent pregnancy loss and assess the effectiveness of low dose aspirin and low molecular weight heparin in having a better obstetric outcome.Methods: This study was conducted in a private hospital in Mahabubnagar from June 2017 to May 2019. A total of 80 pregnant ladies who had previous 2 and or more pregnancy losses in the early (before 20 weeks) or late (after 20 weeks) pregnancy period was included in the study. 80 pregnant women with idiopathic/unexplained recurrent pregnancy loss were properly evaluated in regard to the history of previous period of gestation of loss, previous scans in regard to documentation of fetal pole and gestation, cardiac activity, anomaly scan and growth scan and any special investigations in previous pregnancies and present pregnancy.Results: A total 80 pregnant women with previous 2 and more unexplained pregnancy losses who were evaluated and found negative with major causes of pregnancy losses half of them (40) were treated with low dose aspirin alone and the other 40 women were treated with a combination of low dose aspirin (75 mg) and low molecular weight Heparin (20 mg) daily low molecular weight heparin till term. The aspirin alone group had 82.5% live birth rate and the combination group had 92.5% live birth rate which is quite satisfactory and more than the Aspirin alone group.Conclusions: Use of combination of low dose aspirin and low molecular weight heparin seems to be a good choice of drugs in treating the unexplained recurrent pregnancy losses than low dose aspirin alone.

scholarly journals Anticardiolipin Positivity Is Highly Associated With Intrauterine Growth Restriction in Women With Antiphospholipid Syndrome

2020 ◽  
Vol 26 ◽  
pp. 107602962097445
Author(s):  
Fangfang Xi ◽  
Yuliang Cai ◽  
Min Lv ◽  
Ying Jiang ◽  
Feifei Zhou ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Intrauterine Growth Restriction ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Low Molecular Weight ◽  
Intrauterine Growth ◽  
Factors Associated ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Adverse Pregnancy

The purpose of our study was to evaluate pregnancy outcomes of women with antiphospholipid antibodies (aPL) positivity and assess risk factors associated with adverse pregnancy outcomes. Pregnant women with aPL positivity were enrolled prospectively in China from January 2017 to March 2020. Treatment of low-dose aspirin and low molecular weight heparin were given. Pregnancy outcomes and coagulation function were recorded and compared with normal pregnancies. Multivariable logistic regression was performed to identify risk factors associated to intrauterine growth restriction (IUGR). 270 pregnant women, including 44 diagnosed as Antiphospholipid syndrome (APS), 91 as non-criteria APS (NCAPS) and 135 normal cases as control, were enrolled in the study. The live birth rate in aPL carriers and APS group was 97% and 95.5%, respectively. Adverse pregnancy outcomes did not show significant difference between aPL carriers and normal pregnancies, and between APS and NCAPS, except for IUGR. The incidence of IUGR was significantly higher in aPL carriers than normal pregnancies, and in APS patients than NCAPS (P < 0.05). After controlling for age, in vitro fertilization (IVF), pregnancy losses related to APS and treatment, anticardiolipin (aCL) positivity was the only variable significantly associated with IUGR, with an adjusted odds ratio of 4.601 (95% CI, 1.205-17.573). Better pregnant outcomes of aPL positive women, include APS and NCAPS, were achieved in our study with treatment based on low-dose aspirin (LDA) plus low molecular weight heparin (LMWH). The incidence of IUGR was still higher in them, and aCL positivity was the only one risk factor associated with IUGR.

Pregnancies in Patients with Philadelphia Negative Chronic Myeloproliferative Disorders: Interim Report of the European LeukemiaNet Data Base

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2806-2806
Author(s):  
Sabine Struve ◽  
Guido Finazzi ◽  
Konstanze Doehner ◽  
Stefanie Schauer ◽  
Eva Lengfelder ◽  
...  
Keyword(s):  
Birth Rate ◽  
Low Dose ◽  
Myeloproliferative Disorders ◽  
Low Molecular Weight ◽  
Innere Medizin ◽  
Maternal Complications ◽  
Jak2 Mutation ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Bleeding Episodes

Abstract Background: Philadelphia negative chronic myeloproliferative disorders (CMPDs) frequently present in women of childbearing age. Due to the high incidence of thromboembolic and hemorrhagic complications management of pregnancy is difficult in these patients. In order to document the course and outcome of pregnancies in CMPDs a registry has been implemented within the European LeukemiaNet project (work package 9). Case report forms are available via internet (http://www.uniklinik-ulm.de/struktur/kliniken/innere-medizin/klinik-fuer-innere-medizin-iii/home/studienzentrale/therapiestudien/cmps.html). A management strategy for pregnancy in CMPDs is proposed according to the experience of the authors and the available data in the literature [Griesshammer M. et al. Semin Thromb Hemost2006; 32: 422–9]. Results: From 01/2004 until 08/2008 we have registered 104 pregnancies in 52 patients including 43 patients with essential thrombocythemia (ET), 8 with polycythemia vera (PV) and 1 with primary myelofibrosis (PMF). Patients have been recruited by 7 centers from 6 countries (Austria, Czech Republic, Germany, Italy, Slovakia, Switzerland). The median age was 31,5 years (range 20,5 – 42,5 years). Seven of the 104 pregnancies are still ongoing, 8 have been terminated by elective abortion. The remaining 89 pregnancies had a life birth rate of 72% (64/89). A full-term normal delivery was observed in 86% (55/64). Spontaneous abortion was the most frequent complication occurring in 25% (22/89), mostly during the first trimester of pregnancy. Other complications such as stillbirth, premature delivery and intrauterine growth retardation occurred in 14% (12/89). The cumulative incidence of severe maternal complications was 9% (8/89), i.e. 2 cases of preeclampsia, 2 major thromboembolic events and 4 major bleeding episodes; furthermore 4 cases of microcirculatory disturbances and 2 minor bleeding episodes, i.e. recurrent epistaxis, were reported. Major thromboembolic events included a splenic vein thrombosis and a thrombotic occlusion of the vertebral artery. All major bleeding episodes were associated with obstetrical complications such as preterm detachment of the placenta, metratonia and peripartal injuries such as perineal and vaginal laceration. About half of our patients (50%) received no treatment during pregnancy, 20% had low-dose aspirin alone, 14% had low-dose aspirin plus low molecular weight heparin and the remaining patients (3%) had interferon alpha plus low-dose aspirin with or without low molecular weight heparin. In 13% information concerning treatment is still lacking. Interestingly, patients with the Jak2 mutation showed a significantly lower life birth rate compared to patients without (p = 0,0354). Conclusions: Pregnancies in CMPDs, especially ET, go along with a live birth rate around 72%. Spontaneous abortion is the most frequent fetal complication. Maternal complications are relatively rare, nevertheless severe thromboembolic and hemorrhagic events do occur, the latter especially in context with obstetrical complications. The Jak2 mutation seems to be a significant risk factor for adverse pregnancy outcome.

Thromboprophylaxis in Multiple Myeloma: Indian Perspective

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5207-5207
Author(s):  
Velu Nair ◽  
Satyaranjan Das ◽  
Ajay Sharma ◽  
Deepak Kumar Mishra ◽  
Shilajit Bhattacharya ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Multiple Myeloma ◽  
Developing Countries ◽  
Adverse Effects ◽  
Venous Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Low Molecular Weight ◽  
Dose Aspirin ◽  
Low Dose Aspirin

Abstract Background: Hypercoagulability has been observed in patients of multiple myeloma and has been associated with deep venous thrombosis (DVT). There is growing evidence of increased rate of venous thromboembolism associated with use of thalidomide, an anti angiogenesis drug, especially when combined with other agents such as dexamethasone and doxorubicin. Currently there is no consensus on the most appropriate prophylactic approach for thrombotic episodes in patients of multiple myeloma treated with thalidomide containing regimen. Although newer thalidomide derivatives with less thrombogenic adverse effects are being used in the developed countries, in developing countries like India due to financial constraints thalidomide remains the 1st line drug for multiple myeloma. Further there are scant reports of multiple myeloma related thrombosis and thrombo prophylactic regimen from developing countries. Objectives: To evaluate the incidence of symptomatic as well as asymptomatic thrombosis at onset of the disease as well as during treatment, the efficacy of low dose aspirin and low molecular weight heparin as thromboprophylaxis and their adverse effects in multiple myeloma patients treated with thalidomide and dexamethasone regimen. Patients and Methods: 30 patients of multiple myeloma reporting to our centre from May 2006 to March 2008 comprised the study group. Patient with past history of bleeding, thrombocytopenia and deranged coagulation parameters were excluded from the study. The male to female ratio was 3:2. The median age was 56 years (39–70). 23 patients were de-novo and 7 patients were relapse cases. Before starting therapy in addition to diagnostic and prognostic work up, all patients were evaluated for symptomatic as well as asymptomatic DVT with the help of Color Doppler Flow Index (CDFI) study and d-dimer estimation. Patients were randomized to low dose aspirin (Aspirin 150 mg once a day) and low molecular weight heparin (Enoxapirin 40 mg once a day). All patients were administered dexamethasone pulses of 40 mg once a day from day 1 to 4 in each cycle of 28 days. Thalidomide was started at a dose of 100mg once a day and increased to maximum of 400 mg depending on tolerability (median dose 200 mg). None of the patients received erythropoietin. All patients were evaluated for DVT at the beginning of each cycle during the first three cycles. Thromboprophylaxis was administered for first three cycles only. The response to therapy was evaluated at completion of 3rd and 6th cycles. Criteria for response were as previously reported by Blade et al. Results: The overall response (OR) after 3 cycles was 18/30 (60%), complete response (CR)-10/30(33.3%), partial response (PR)-8/30(26.7%) and after 6 cycles was 22/28 (78.5%), CR-16/28(57.1%), PR-6/28(21.4%). 2 patients who had progressive disease after 3 cycles were changed to Bortezumib containing regimen. Out of 30 patients only one patient (3.3%) a 70 yr old male had deep vein thrombosis at diagnosis which was asymptomatic and the diagnosis was based on CDFI findings. One patient on low dose aspirin had one episode of upper GI bleed on 5th day of the first cycle and thromboprophylaxis was stopped. During the follow up, none of the patient had any evidence of symptomatic as well as asymptomatic DVT. Conclusion: This study suggests that the incidence of venous thrombosis in our cohort of patients were much lower than reported from the west. Both low doses Aspirin as well as low molecular weight heparin are effective agents for thromboprophylaxis. The adverse effects were acceptable. Larger trials would be required to confirm these findings.

Live Term Birth and Two Ongoing Viable Pregnancies with Therapeutic Enoxaparin and Aspirin After Failure of Prophylactic Enoxaparin and Aspirin in Two Women with Thrombophilia and Recurrent Pregnancy Loss.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4184-4184
Author(s):  
Mala Varma ◽  
Vijaya L. Ganesh ◽  
Daniel E. Stein
Keyword(s):  
Molecular Weight ◽  
Pregnant Women ◽  
Ovarian Stimulation ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Anticardiolipin Antibody ◽  
Low Molecular Weight ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Pai 1

Abstract Abstract 4184 The combination of prophylactic heparin and low-dose aspirin was shown in the 1990s to improve pregnancy outcome in patients with antiphospholipid antibodies and recurrent pregnancy loss (RPL). Antiphospholipid antibodies induce placental thrombosis. When associations between hereditary thrombophilias and RPL were reported in the early 2000s, we and other physicians (Rodger MA J Obstr Gyn Canada 2002) began empirically prescribing prophylactic low molecular weight heparin, low-dose aspirin, or the combination to pregnant women with thrombophilia and unexplained RPL. We observed high live birth rates. Data emerged showing live birth rates of 70.2-94% in pregnant women with RPL treated with low-dose low molecular weight heparin and/or low-dose aspirin. Only one report has addressed treatment after failure of low-dose low molecular weight heparin: Brenner and colleagues (Thromb Haemost 2000) treated 3 pregnant women with multiple thrombophilic defects with enoxaparin 60 mg x 2/day after failure of enoxaparin 40 mg x 2/day; all 3 pregnancies yielded live births. We report cases of a live term birth and two ongoing viable pregnancies with therapeutic enoxaparin,1.5 mg/kg SC, (TEP) and aspirin after failure of prophylactic enoxaparin, 40 mg SC, (PEP) and aspirin in two women with thrombophilia and RPL. A 33 year-old woman with a history of 2 unexplained miscarriages at 6 weeks (Patient 1) and a 42 year-old woman with a history of 3 unexplained miscarriages at 8 weeks (Patient 2) presented in April 2006 and in August 2007 respectively. Uterine malformations, acquired uterine defects, and hormonal abnormalities were ruled out. Parental karyotypes were normal. Thrombophilia evaluation included: factor V Leiden, prothrombin gene mutation, methylene tetrahydrofolate reductase (MTHFR) gene mutation, fasting homocysteine, protein C, protein S, antithrombin, IgG anticardiolipin antibody, IgM anticardiolipin antibody, lupus anticoagulant, plasminogen activator inhibitor-1 (PAI-1), and PAI-1 4G/5G polymorphism. Positive results were: one copy each of the C677T and A1298C MTHFR mutations in Patient 1 and Patient 2; PAI-1 120 ng/mL and PAI-1 4G/4G polymorphism in Patient 2. The following describes the clinical course in both patients. Patient 1 was started on aspirin 81 mg daily and on clomiphene citrate to improve fertility. She conceived but miscarried at 7 weeks in June 2006. She underwent in vitro fertilization (IVF) in December 2006 while continuing on aspirin. She started on PEP daily within 24 hours of egg retrieval. She miscarried twins at 6 and 8&1/2 weeks. In May 2007, she conceived through IVF while continuing on aspirin. She started on TEP daily within 24 hours of egg retrieval. Anti-Xa level was monitored monthly. Enoxaparin was adjusted to maintain the anti-Xa level between 0.6 and 1.2 ui/mL. She delivered a healthy term baby on January 10, 2008. She continued to take aspirin daily. She conceived naturally in February 2009. She started on TEP daily with monthly anti-Xa monitoring when her pregnancy was confirmed. She currently has a live 24-week gestation. Patient 2 was started on aspirin 81 mg daily. She conceived through IVF in May 2008. She started on PEP daily within 24 hours of egg retrieval. She miscarried in a few weeks. She conceived through IVF in October 2008 while continuing on aspirin. She started on PEP daily within 24 hours of egg retrieval. After two weeks when her pregnancy was confirmed PEP was increased to TEP. She miscarried in a few weeks. She conceived in May 2009 through IVF while continuing on aspirin. TEP with monthly anti-Xa monitoring was started prior to IVF when she started her ovarian stimulation medications. She currently has a live 16-week gestation. Our report corroborates the findings by Brenner and colleagues of a benefit of an increased enoxaparin dose after failure of a low dose. It is possible that the higher dose leads to better control of a placental thrombotic state. While the timing of initiation of thromboprophylaxis has been established for natural pregnancies (aspirin is started pre-conception; enoxaparin is started at pregnancy confirmation or at detection of the fetal heartbeat), optimal time for initiation of thromboprophylaxis in IVF pregnancies has not been determined. Ovarian stimulation for IVF leads to a hyperestrogenic state which increases thrombotic risk. It is possible that starting TEP at the time of initiation of ovarian stimulation in Patient 2 enabled her ongoing viable second-trimester pregnancy by optimizing placental conditions. Disclosures: Off Label Use: Aspirin and enoxaparin during pregnancy to prevent recurrent fetal loss.

scholarly journals THE MANAGEMENT OF WOMEN WITH THROMBOPHILIA IN PREPARATION FOR IN VITRO FERTILIZATION

2012 ◽  
Vol 61 (5) ◽  
pp. 60-67
Author(s):  
Marina Ivanovna Mirashvili ◽  
Marina Sabirovna Zaynulina ◽  
Igor Yuryevich Kogan ◽  
Aleksandr Mkrtychiyevich Gzgzyan ◽  
Roza Nuraddinovna Rzayeva
Keyword(s):  
Laboratory Data ◽  
Control Group ◽  
Low Molecular Weight ◽  
Vitro Fertilization ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Adjusted Dose ◽  
Pai 1 ◽  
Acquired Thrombophilia

The aim was to study changes in the hemostatic system in women with hereditary and acquired thrombophilia in IVF cycle, the possibility of their drugs correction, as well as the effect of this therapy on the outcome of IVF. We examined 119 women with congenital or acquired thrombophilia during preparation or during IVF cycle. In the presence of abnormalities in laboratory data, combination of weight adjusted dose of the low molecular weight heparin, low dose aspirin and folic acid administered to the severity of coagulation disorders and homocystein level. In the group of patients with a history 3 or more IVF failures APS was diagnosed in 36.6 % of women. In this group the frequency of mutations in genes: PAI-1, PLAT, fibrinogen was significantly higher than in control group (83.3 % and 58.33 %, 40 % and 19.44 %, 50 % and 25 % respectively, p < 0.05), as well as mutations in genes PAI-1 and PLAT combination rate (31.03 % and 13.89 % respectively, p < 0,05) and the frequency of combinations of 3 or more mutations (65.51 % and 19.44 %, p < 0.001). In the group of women with thrombophilia (n = 97) treated with this therapy 52.57 % IVF cycles was successful. At 36.08 % pregnancies ended with childbirth. In the subgroup of women with 3 or more IVF failures (n = 26) the pregnancy rate was 38.46 %.

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