The importance of hemostasis control for anticoagulant therapy during post-IVF pregnancy in patients with burdened obstetric history

Aim: to evaluate the clinical significance of hemostasis control during anticoagulant therapy in patients with post-in vitro fertilization (IVF) pregnancy and burdened obstetric history (ВОН).

Materials and Methods. A prospective observational clinical comparative study was conducted. The main group consisted of 64 women with ВОН, with singleton (subgroup I1, n = 38) and multiple (dichoric diamniotic twins) pregnancies (subgroup I2, n = 26) following IVF, used low molecular weight heparins (LMWH). Control group: 35 pregnant women with singleton pregnancies (subgroup C1) and 35 with twins (subgroup C2) following IVF. Hemostasis was assessed by measuring APTT (activated partial thromboplastin time), PT (prothrombin time), TT (thrombin time), fibrinogen, antithrombin, protein C, protein S, protein C function (test РrоС Global); D-dimer; platelet aggregation with ristocetin, ADP (adenosine-5-diphosphate) and collagen, anti-Xa activity, thromboelastography, antiphospholipid antibodies and genetic thrombophilia.

Results. Post-IVF pregnancy in patients with ВОН and the risk of thrombosis during controlled anticoagulant prophylaxis was accompanied by lowered incidence of complications compared with control group: impaired uteroplacental blood flow was observed in 7.8 % vs. 24.3 % (p < 0.05), fetal growth restriction – in 3.1 % vs. 12.9 % (p < 0.05), preeclampsia – in 6.3 % vs. 20.0 % (p < 0.05), threat of pregnancy termination in the first trimester – in 14.1 % vs. 28.6 % (p < 0.05), in the second trimester – in 7.8 % vs. 21.4 % (p < 0.05). The controlled LMWH use was associated with favorable pregnancy course and outcome. Assessing dynamics of hemostasis parameters during anticoagulant and antiplatelet therapy allowed to substantiate the need to increase LMWH dose during pregnancy progression, to assess its adequacy and safety.

Conclusion. The increased hypercoagulation upon pregnancy progression requires monitoring the adequacy of anticoagulation therapy in risk groups, especially in post-IVF multiple pregnancies.

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