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Heparin prophylaxis of gestational complications in women with Factor V Leiden mutation (GA genotype)

https://doi.org/10.17749/2313-7347.2018.12.2.021-031

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Abstract

The aim of the study was to determine the efficacy of heparin prophylaxis in preventing pregnancy complications in patients with the manifested laboratory phenotype – resistance to activated protein C (APC-resistance with NR ≤ 0.49) Factor V Leiden mutation (GA genotype). Materials and methods. A single-center, randomized, controlled trial of 141 pregnant women – carriers of the FVL(1691)GA mutation with APC-resistance ≤ 0.49 was determined at a gestation age of 7-8 weeks. Of these, 70 patients were included in the main group (mean age 30.2 ± 4.7 years); after the confirmation of the APC-resistance at 7-8 weeks of gestation, these women received a 14 day low-molecular-weight heparin (LMWH) course at elevated prophylactic doses. The comparison group (71 pregnant women of 30.3 ± 3.9 years old) received no LMWH. Results. The heparin prophylaxis (started from 7-8 weeks of gestation) at elevated doses in carriers of the FVL(1691)GA mutation with pronounced APC-resistance reduced the absolute risk (ARR) of pre-eclampsia by 29.5% (ARR: 29.5; p = 0.0003; NTT: 3.4; 95% Cl: 2.356.12), the risk of fetal growth retardation by 23.8% (ARR: 23.8; p = 0.0016; NTT: 4.2; 95% Cl: 2.8-8.7) and the risk of induced premature birth by 12.6% (ARR: 12.6; p = 0.0242; NTT: 5.8; 95% Cl: 3.7-14.1). Conclusion. The administration of LMWH at prophylactic doses for 14 days is indicated in patients with a manifested subclinical (laboratory) phenotype (APC-resistance with NR ≤ 0.49) of the FVL(1691)GA mutation starting from the gestation period of 7-8 weeks. If necessary (with a value of NR ≤ 0.49), it is advisable to repeat the courses of heparin prophylaxis at 18-19 and 27-28 weeks of pregnancy.

About the Authors

M. G. Nikolaeva
Altai State Medical University, Health Ministry of Russian Federation
Russian Federation

Nikolaeva Mariya Gennad'evna – PhD, Associate Professor, Department of Obstetrics and Gynecology

40, pr. Lenina, Barnaul, 656038



A. P. Momot
Altay Branch of National Research Center for Hematology, Health Ministry of Russian Federation
Russian Federation

Momot Andrey Pavlovich – MD, Professor, Director

1, ul. Lyapidevskogo, Barnaul, 656045



M. S. Zainulina
I.P. Pavlov First Saint Petersburg State Medical University, Health Ministry of Russian Federation; Maternity Hospital № 6 named after professor V.F. Snegirev
Russian Federation

Zainulina Marina Sabirovna – MD, Professor, Department of Obstetrics, Gynecology and Reproduction, I.P. Pavlov FSPb SMU HM of RF; Physician-in-Chief of Snegirev Maternity Hospital № 6

1, ul. Lyapidevskogo, Barnaul, 656045,

5, ul. Mayakovskogo, Saint Petersburg, 192014



K. A. Momot
Altai Regional Clinical Hospital
Russian Federation

Momot Ksenia Andreevna – Hematologist

1, ul. Lyapidevskogo, Barnaul, 656045



N. N. Yasafova
Altai Regional Clinical Hospital
Russian Federation

Yasafova Natalya Nikolaevna – Hematologist

1, ul. Lyapidevskogo, Barnaul, 656045



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For citation:


Nikolaeva M.G., Momot A.P., Zainulina M.S., Momot K.A., Yasafova N.N. Heparin prophylaxis of gestational complications in women with Factor V Leiden mutation (GA genotype). Obstetrics, Gynecology and Reproduction. 2018;12(2):21-31. (In Russ.) https://doi.org/10.17749/2313-7347.2018.12.2.021-031

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ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)