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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher-id">akusherstvo</journal-id><journal-title-group><journal-title xml:lang="en">Obstetrics, Gynecology and Reproduction</journal-title><trans-title-group xml:lang="ru"><trans-title>Акушерство, Гинекология и Репродукция</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2313-7347</issn><issn pub-type="epub">2500-3194</issn><publisher><publisher-name>IRBIS LLC</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.17749/2313-7347/ob.gyn.rep.2026.756</article-id><article-id custom-type="elpub" pub-id-type="custom">akusherstvo-2865</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>REVIEW ARTICLE</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>НАУЧНЫЙ ОБЗОР</subject></subj-group></article-categories><title-group><article-title>Personalized hemostasis correction in recurrent pregnancy loss: analysis of current data, clinical controversies, and prospects</article-title><trans-title-group xml:lang="ru"><trans-title>Персонализированная коррекция гемостаза при рецидивирующей потере беременности: анализ современных данных, клинических контроверсий и перспектив</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8688-5695</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Карпова</surname><given-names>И. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Karpova</surname><given-names>I. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Карпова Ирина Адамовна, к.м.н.</p><p>Scopus Author ID: 57198166390, WoS ResearcherID: X-5325-2018. </p><p>625023 Тюмень, Одесская ул., д. 54</p></bio><bio xml:lang="en"><p>Irina A. Karpova, MD, PhD.</p><p>Scopus Author ID: 57198166390, WoS ResearcherID: X-5325-2018. </p><p>54 Odesskaya Str., Tyumen 625023</p></bio><email xlink:type="simple">Karpovai.73@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0005-5978-9004</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Платицын</surname><given-names>В. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Platitsyn</surname><given-names>V. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Платицын Виктор Анатольевич, к.м.н.</p><p>WoS ResearcherID: PJC-2713-2026. </p><p>625023 Тюмень, Одесская ул., д. 54</p></bio><bio xml:lang="en"><p>Victor A. Platitsyn, MD, PhD.</p><p>WoS ResearcherID: PJC-2713-2026. </p><p>54 Odesskaya Str., Tyumen 625023</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0000-4024-4884</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Павленко</surname><given-names>А. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Pavlenko</surname><given-names>A. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Павленко Анастасия Сергеевна </p><p>WoS ResearcherID: PHW-1098-2026.</p><p>625023 Тюмень, Одесская ул., д. 54; 620028 Екатеринбург, ул. Репина, д. 3</p></bio><bio xml:lang="en"><p>Anastasia S. Pavlenko, MD.</p><p>WoS ResearcherID: PHW-1098-2026.</p><p>54 Odesskaya Str., Tyumen 625023; 3 Repina Str., Ekaterinburg 620028</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Матейкович</surname><given-names>Е. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Mateykovich</surname><given-names>E. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Матейкович Елена Александровна, к.м.н.</p><p>Scopus Author ID: 57203244309, WoS ResearcherID: GYD-8298-2022. </p><p>625023 Тюмень, Одесская ул., д. 54</p></bio><bio xml:lang="en"><p>Elena A. Mateykovich, MD, PhD.</p><p>Scopus Author ID: 57203244309, WoS ResearcherID: GYD-8298-2022. </p><p>54 Odesskaya Str., Tyumen 625023</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7008-1107</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Полякова</surname><given-names>В. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Polyakova</surname><given-names>V. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Полякова Валентина Анатольевна, д.м.н., проф. </p><p>Scopus Author ID: 57202233581, WoS ResearcherID: AAE-7314-2019. </p><p>625023 Тюмень, Одесская ул., д. 54</p></bio><bio xml:lang="en"><p>Valentina A. Polyakova, MD, Dr Sci Med, Prof.</p><p>Scopus Author ID: 57202233581, WoS ResearcherID: AAE-7314-2019. </p><p>54 Odesskaya Str., Tyumen 625023</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7019-6630</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шевлюкова</surname><given-names>Т. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Shevlyukova</surname><given-names>T. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Шевлюкова Татьяна Петровна, д.м.н. </p><p>Scopus Author ID: 57196485822. </p><p>625023 Тюмень, Одесская ул., д. 54</p></bio><bio xml:lang="en"><p>Tatyana P. Shevlyukova, MD, Dr Sci Med.</p><p>Scopus Author ID: 57196485822. </p><p>54 Odesskaya Str., Tyumen 625023</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8275-3553</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Кукарская</surname><given-names>И. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Kukarskaya</surname><given-names>I. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кукарская Ирина Ивановна, д.м.н.</p><p>Scopus Author ID: 57200070759.</p><p>625023 Тюмень, Одесская ул., д. 54; 625002 Тюмень, ул. Даудельная, 1</p></bio><bio xml:lang="en"><p>Irina I. Kukarskaya, MD, Dr Sci Med.</p><p>Scopus Author ID: 57200070759. </p><p>54 Odesskaya Str., Tyumen 625023; 1 Daudelnaya str., Tyumen 625002 </p></bio><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0001-8166-3388</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Некрасова</surname><given-names>М. Р.</given-names></name><name name-style="western" xml:lang="en"><surname>Nekrasova</surname><given-names>M. R.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Некрасова Мария Рафаэльевна, д.м.н., проф. </p><p>Scopus Author ID: 6701799740, WoS ResearcherID: PIF-9002-2026. </p><p>625023 Тюмень, Одесская ул., д. 54; 625023 Тюмень, ул. Котовского, д. 55</p></bio><bio xml:lang="en"><p>Maria R. Nekrasova, MD, Dr Sci Med, Prof.</p><p>Scopus Author ID: 6701799740, WoS ResearcherID: PIF-9002-2026. </p><p>54 Odesskaya Str., Tyumen 625023; 55, Kotovskogo Str., Tyumen 625023</p></bio><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1530-099X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Созонов</surname><given-names>А. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Sozonov</surname><given-names>A. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Созонов Алексей Иванович, к.м.н. </p><p>Scopus Author ID: 0000-0003-1530-099X, WoS ResearcherID: H-6344-2016. </p><p>625023 Тюмень, Одесская ул., д. 54</p></bio><bio xml:lang="en"><p>Aleksey I. Sozonov, MD, PhD.</p><p>Scopus Author ID: 0000-0003-1530-099X, WoS ResearcherID: H-6344-2016.</p><p>54 Odesskaya Str., Tyumen 625023</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБОУ ВО «Тюменский государственный медицинский университет» Министерства здравоохранения Российской Федерации</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Tyumen State Medical University, Ministry of Health of the Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ФГБОУ ВО «Тюменский государственный медицинский университет» Министерства здравоохранения Российской Федерации; ФГБОУ ВО «Уральский государственный медицинский университет» Министерства здравоохранения Российской Федерации</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Tyumen State Medical University, Ministry of Health of the Russian Federation; Ural State Medical University, Ministry of Health of the Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>ФГБОУ ВО «Тюменский государственный медицинский университет» Министерства здравоохранения Российской Федерации; ГБУЗ Тюменской области «Перинатальный центр» (г. Тюмень)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Tyumen State Medical University, Ministry of Health of the Russian Federation; Tyumen Region Perinatal Center</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>ФГБОУ ВО «Тюменский государственный медицинский университет» Министерства здравоохранения Российской Федерации; ГБУЗ Тюменской области «Областная клиническая больница № 1»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Tyumen State Medical University, Ministry of Health of the Russian Federation; Regional Clinical Hospital № 1</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2020</year></pub-date><pub-date pub-type="epub"><day>30</day><month>06</month><year>2026</year></pub-date><volume>0</volume><issue>0</issue><issue-title>Online First</issue-title><elocation-id>2865</elocation-id><permissions><copyright-statement>Copyright &amp;#x00A9; Karpova I.A., Platitsyn V.A., Pavlenko A.S., Mateykovich E.A., Polyakova V.A., Shevlyukova T.P., Kukarskaya I.I., Nekrasova M.R., Sozonov A.I., 2020</copyright-statement><copyright-year>2020</copyright-year><copyright-holder xml:lang="ru">Карпова И.А., Платицын В.А., Павленко А.С., Матейкович Е.А., Полякова В.А., Шевлюкова Т.П., Кукарская И.И., Некрасова М.Р., Созонов А.И.</copyright-holder><copyright-holder xml:lang="en">Karpova I.A., Platitsyn V.A., Pavlenko A.S., Mateykovich E.A., Polyakova V.A., Shevlyukova T.P., Kukarskaya I.I., Nekrasova M.R., Sozonov A.I.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.gynecology.su/jour/article/view/2865">https://www.gynecology.su/jour/article/view/2865</self-uri><abstract><sec><title>Aim</title><p>Aim: to systematize current evidence and analyze the effectiveness of personalized approaches to correcting hemostatic disorders for preventing recurrent pregnancy loss and placenta-mediated complications.</p></sec><sec><title>Materials and Methods</title><p>Materials and Methods. A systematic search for publications from 1999 to 2025 was conducted in PubMed/MEDLINE, eLibrary, CyberLeninka, DOAJ (for scientific articles) and FIPS (for patent documents) databases. Using combined MeSH queries, 412 records were initially identified. After removing duplicates and performing multi-stage screening, 63 full-text publications were included in the final analysis. Due to clinical and methodological heterogeneity across studies, a qualitative narrative synthesis of the data was performed.</p></sec><sec><title>Results</title><p>Results. Hemostatic dysregulation serves as a universal pathogenetic arm in pregnancy loss, manifesting through chorionic villi microthrombosis and placental dysfunction. The combination of acetylsalicylic acid (ASA) 100–150 mg and prophylactic doses of low-molecular-weight heparins (LMWHs) significantly increases live birth rates in antiphospholipid syndrome. It is emphasized that isolated carriage of thrombophilia gene polymorphisms is not an independent indication for LMWHs; their use is pathogenetically and clinically justified only when combined with additional risk factors, such as verified antiphospholipid syndrome (APS), a history of thrombosis, or multiple pregnancy losses. For primary preeclampsia prevention, ASA efficacy at 150 mg initiated at 11–14 weeks of gestational age is well established. The critical importance of preconception administration of active folates for hyperhomocysteinemia correction is confirmed. Integral monitoring via thrombodynamics enables tracking of trimester-specific coagulation changes and personalizing antithrombotic dosing. Sulodexide and dipyridamole demonstrate clinical potential in improving uteroplacental blood flow in fetoplacental insufficiency.</p></sec><sec><title>Conclusion</title><p>Conclusion. The contemporary management paradigm for these patients requires a shift from empirical regimens to risk stratification and early preconception screening. Optimal clinical strategy is based on evidence-based ASA prescription, strictly differentiated use of LMWHs, folate metabolism correction, and dynamic therapy control using thrombodynamics. The presented data will help minimize iatrogenic complications and define the trajectory for future multicenter studies.</p></sec></abstract><trans-abstract xml:lang="ru"><sec><title>Цель</title><p>Цель: систематизировать современные данные и проанализировать эффективность персонализированных подходов к коррекции нарушений системы гемостаза для профилактики рецидивирующей потери беременности и плацентарно-опосредованных осложнений.</p></sec><sec><title>Материалы и методы</title><p>Материалы и методы. Выполнен систематический поиск в базах PubMed/MEDLINE, eLibrary, КиберЛенинка, DOAJ (для научных статей) и ФИПС (для патентных документов) за период 1999–2025 гг. По комбинированным MeSH-запросам первично идентифицировано 412 записей. После удаления дубликатов и многоэтапного скрининга в окончательный анализ включено 63 публикации. Ввиду клинико-методологической гетерогенности исследований выполнен качественный нарративный синтез данных.</p></sec><sec><title>Результаты</title><p>Результаты. Дисрегуляция гемостаза выступает универсальным патогенетическим звеном репродуктивных потерь, реализуясь через микротромбозы ворсин хориона и плацентарную дисфункцию. Комбинация ацетилсалициловой кислоты (АСК) 100–150 мг и профилактических доз низкомолекулярных гепаринов (НМГ) достоверно повышает частоту живорождений при антифосфолипидном синдроме (АФС). Подчеркнуто, что изолированное носительство полиморфизмов генов тромбофилии не является самостоятельным показанием к назначению НМГ; их применение патогенетически и клинически обосновано исключительно при сочетании с дополнительными факторами риска: верифицированным АФС, тромбозами в анамнезе или множественными репродуктивными потерями. Для первичной профилактики преэклампсии доказана эффективность АСК 150 мг, инициируемой с 11–14 недель. Установлена критическая значимость прегравидарного назначения активных фолатов для коррекции гипергомоцистеинемии. Интегральный мониторинг методом тромбодинамики позволяет отслеживать триместр-специфические изменения коагуляции и персонализировать дозы антитромботиков. Препараты сулодексид и дипиридамол демонстрируют клинический потенциал в улучшении маточно-плацентарного кровотока при фетоплацентарной недостаточности.</p></sec><sec><title>Заключение</title><p>Заключение. Современная парадигма ведения пациенток требует перехода от эмпирических схем к стратификации рисков и раннему прегравидарному скринингу. Оптимальная тактика базируется на доказательном назначении АСК, строгом дифференцированном применении НМГ, коррекции метаболизма фолатов и динамическом контроле терапии посредством тромбодинамики. Представленные данные позволят минимизировать ятрогенные осложнения и определить вектор будущих многоцентровых исследований.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>рецидивирующая потеря беременности</kwd><kwd>гемостаз</kwd><kwd>антифосфолипидный синдром</kwd><kwd>АФС</kwd><kwd>тромбофилия</kwd><kwd>низкомолекулярные гепарины</kwd><kwd>НМГ</kwd><kwd>ацетилсалициловая кислота</kwd><kwd>АСК</kwd><kwd>преэклампсия</kwd><kwd>плацентарная недостаточность</kwd></kwd-group><kwd-group xml:lang="en"><kwd>recurrent pregnancy loss</kwd><kwd>hemostasis</kwd><kwd>antiphospholipid syndrome</kwd><kwd>APS</kwd><kwd>thrombophilia</kwd><kwd>low-molecular-weight heparins</kwd><kwd>LMWHs</kwd><kwd>acetylsalicylic acid</kwd><kwd>ASA</kwd><kwd>preeclampsia</kwd><kwd>placental insufficiency</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Гарданова Ж.Р., Хритинин Д.Ф., Антуфьева М.А. и др. 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