Low molecular weight heparin prophylaxis for placenta-mediated complications in women with F2G20210A mutation

Introduction. A prothrombin-mutant genotype is a known risk factor in gestational complications.Aim — efficacy assessment in pregravid heparin prevention of pre-eclampsia (PE) and foetal growth retardation (FGR) in females with F2G20210A genotype and suprathreshold prothrombin activity.Patients and methods. A single-centre randomised controlled study enrolled 80 pregnant women carrying prothrombin F2G20210A. The inclusion criterion was a pregravid plasma prothrombin activity > 171 %. The study cohort consisted of 50 women (mean age 31.2 ± 3.7 years) receiving low molecular-weight heparin (LMWH) in menstrual cycle at weight-based elevated prevention doses. A comparison group comprised 30 pregnant women (mean age 31.3 ± 2.9 years) not receiving LMWH prophylaxis.Results. A pregravid start of LMWH treatment at high prophylactic doses in F2G20210A genotype carriers with prothrombin activity > 171 % allowed an absolute risk reduction (ARR) of PE by 46.7 % [p = 0.0001; number needed to treat (NNT): 2.1; 95 % confidence interval (CI) 3.4–1.56], severe PE by 30.7 % [p = 0.0001; NTT: 3.3; 95 % CI (6.7–2.2)] and FGR by 30.7 % [p = 0.0001; NTT: 3.3; 95 % CI (6.7–2.2)].Conclusion. Use of LMWH is justified in prevention of placenta-mediated complications in F2G20210A genotype carriers with a suprathreshold-high prothrombin activity.

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Thrombocytopenia in pregnant women with thrombophilia treated with low-molecular-weight heparin

Obstetrica şi Ginecologia ◽

10.26416/obsgin.67.1.2019.2295 ◽

2019 ◽

Vol 1 (67) ◽

pp. 30

Author(s):

Melinda-Ildiko Mitranovici ◽

Smaranda Ilea ◽

Mihai Morariu ◽

Daniel Mureşan ◽

Izabella Petre

Keyword(s):

Molecular Weight ◽

Pregnant Women ◽

Low Molecular Weight Heparin ◽

Low Molecular Weight

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Anti-Factor Xa Plasma Levels in Pregnant Women Receiving Low Molecular Weight Heparin Thromboprophylaxis

Obstetrics and Gynecology ◽

10.1097/aog.0b013e31819b3b38 ◽

2009 ◽

Vol 113 (3) ◽

pp. 740 ◽

Cited By ~ 2

Author(s):

Ingrid Pabinger ◽

Andreas Greinacher

Keyword(s):

Molecular Weight ◽

Pregnant Women ◽

Plasma Levels ◽

Low Molecular Weight Heparin ◽

Factor Xa ◽

Low Molecular Weight

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Thrombin generation and low-molecular-weight heparin prophylaxis in pregnant women with thrombophilia

Thrombosis and Haemostasis ◽

10.1160/th14-05-0452 ◽

2015 ◽

Vol 113 (02) ◽

pp. 283-289 ◽

Cited By ~ 3

Author(s):

Anna Selmeczi ◽

Rachel E. J. Roach ◽

Csaba Móré ◽

Zoltán Batta ◽

Jolán Hársfalvi ◽

...

Keyword(s):

Molecular Weight ◽

Pregnant Women ◽

Low Molecular Weight Heparin ◽

Thrombin Generation ◽

Factor Xa ◽

Peak Effect ◽

Low Molecular Weight ◽

Endogenous Thrombin Potential ◽

Increased Risk ◽

Optimal Approach

SummaryPregnancy is associated with increased risk of venous thromboembolism, especially in the presence of thrombophilia. However, there is no consensus on the optimal approach for thromboprophylaxis in this population. Recent evidence suggests that thrombin generation correlates with the overall procoagulant state of the plasma. Our aim was to evaluate thrombin generation in a prospective cohort of thrombophilic pregnant women, and investigate the effectiveness of low-molecular- weight heparin (LMWH) prophylaxis in pregnancy. Women with severe (n=8), mild (n=47) and no (n=15) thrombophilia were followed throughout their pregnancies. Thrombin generation was evaluated in each trimester as well as five days and eight weeks postpartum (as a reference category). In women undergoing LMWH prophylaxis, thrombin generation and anti-Factor-Xa activity were measured just before and 4 hours after administration (peak effect). Thrombin generation was determined using Technothrombin TGA assay system. For the analysis, median peak thrombin and endogenous thrombin potential were used. Peak thrombin and endogenous thrombin potential were increased during pregnancy compared to the non-pregnant state with the highest results in the severe thrombophilia group. In women receiving LMWH prophylaxis a decrease was observed in thrombin generation at peak effect but over the progression of pregnancy the extent of this decrease reduced in a stepwise fashion. Our results show that thrombin generation demonstrates the hypercoagulable state in thrombophilic pregnancies. In addition, we found the effect of LMWH prophylaxis to progressively decrease with advancing stages of pregnancy.

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Anti-factor Xa Plasma Levels in Pregnant Women Receiving Low Molecular Weight Heparin Thromboprophylaxis

Obstetrics and Gynecology ◽

10.1097/aog.0b013e31818638dc ◽

2008 ◽

Vol 112 (4) ◽

pp. 884-889 ◽

Cited By ~ 33

Author(s):

Nathan S. Fox ◽

S Katherine Laughon ◽

Samuel D. Bender ◽

Daniel H. Saltzman ◽

Andrei Rebarber

Keyword(s):

Molecular Weight ◽

Pregnant Women ◽

Plasma Levels ◽

Low Molecular Weight Heparin ◽

Factor Xa ◽

Low Molecular Weight

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The Relationship between Use of Low Molecular Weight Heparin during Pregnancy and Risk of Peripartum Adverse Events: A Meta-Analysis

Annals of Hematology & Oncology ◽

10.26420/annhematoloncol.2021.1372 ◽

2021 ◽

Vol 8 (11) ◽

Author(s):

Xiaorong Y ◽

◽

Shan L ◽

Shengji S ◽

Tao S ◽

...

Keyword(s):

Molecular Weight ◽

Adverse Events ◽

Pregnant Women ◽

Low Molecular Weight Heparin ◽

Meta Analysis ◽

Cochrane Library ◽

Premature Delivery ◽

Low Molecular Weight ◽

Significant Difference ◽

Fetal Complications

Introduction: To summarize the trials investigated on relationship between low molecular weight heparin use during pregnancy and peripartum adverse events. Meta-analysis was performed to evaluate the effect of Low Molecular Weight Heparin (LMWH) on maternal and fetal complications. Methods: Electronic research was performed in Cochrane Library, MEDLINE and EMBASE through October 2020. The primary outcome was the incidence of maternal and fetal complications during peripartum period. RevMan 5.3 was used for data analysis. Results: 11 articles were finally included. Meta-analysis showed there was no significant difference in abortion, premature delivery, stillbirth, preeclampsia and postpartum hemorrhage events between pregnant women who used LMWH and those who not. Conclusion: Using LMWH in pregnant women does not increase pregnancy related maternal and fetal complications.

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