akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2022.286akusherstvo-1246Research ArticleLECTUREЛЕКЦИЯThrombosis risk and in vitro fertilizationРиск тромбозов и экстракорпоральное оплодотворениеhttps://orcid.org/0000-0002-8980-9783ГрандонеЭ.GrandoneE.

д.м.н., профессор кафедры акушерства и гинекологии Клинического института детского здоровья имени Н.Ф. Филатова, 119991 Москва, ул. Большая Пироговская, д. 2, стр. 4;

руководитель отделения тромбозов и гемостаза, 71013 Сан-Джованни-Ротондо, Viale Cappuccini, д. 1

MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology, 2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991;

Head of the Department of Thrombosis and Hemostasis, 1 Viale Cappuccini, San Giovanni Rotondo 71013

grandoneelvira@gmail.comФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет); Исследовательский центр «Casa Sollievo della Sofferenza»ИталияSechenov University; Research Center «Casa Sollievo della Sofferenza»Italy2022070320221619095Copyright © Grandone E., 20222022Грандоне Э.Grandone E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/1246

Assisted reproductive technologies (ART) have been progressively recognized as a widely applied means to fight against infertility. Women after ART were shown to have higher risk of developing venous thromboembolism (VTE) that might be related to using some drugs, particularly gonadotropins. VTE risk emerges at relatively early time points after ovulation induction being sustained virtually until pregnancy is complete. According to the multi-center RIETE Registry (Spanish, Registro Informatizado de la Enfermedad TromboEmbolica), a risk of developing isolated pulmonary embolism (PE) is elevated in women after ART compared to those receiving hormonal contraceptives as well as women having spontaneous pregnancy. Low-molecular-weight heparins (LMWH) are justified to be used as a preventive means. However, commonly recommended preventive LMWH dose in such patient cohort may not always be sufficient. On the other hand, escalating dose for some LMWH results in increased rate of developing hemorrhages. Hence, it is important to take into consideration what exact type of LMWH as well as its dose and duration of therapy should be prescribed to women after ART that requires to be further investigated. 

Вспомогательные репродуктивные технологии (ВРТ) становятся все более широко применяющимся методом борьбы с бесплодием. У женщин после ВРТ повышен риск развития венозной тромбоэмболии (ВТЭ), что может быть связано с применением ряда препаратов, в частности, гонадотропинов. Риск ВТЭ появляется в достаточно ранние сроки после индукции овуляции и сохраняется фактически до окончания беременности. Согласно данным многоцентрового регистра RIETE (испан. Registro Informatizado de la Enfermedad TromboEmbolica), риск развития изолированной тромбоэмболии легочной артерии (ТЭЛА) выше у женщин после ВРТ, чем у женщин, использующих гормональные контрацептивы, и женщин со спонтанной беременностью. С целью профилактики оправданно использовать низкомолекулярные гепарины (НМГ). Стандартные рекомендуемые профилактические дозы НМГ у данной когорты пациентов не всегда могут быть достаточными. С другой стороны, увеличение доз некоторых НМГ приводит к увеличению частоты развития кровотечений. Поэтому важно учитывать, какой именно НМГ, в какой дозе и с какой продолжительностью курса следует назначать женщинам после ВРТ. Для этого необходимы дальнейшие исследования. 

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The authors declare that there are no conflicts of interest present.