PREGNANCY IN WOMEN WITH HISTORY OF ISCHEMIC STROKE AND THROMBOPHILIA
Abstract
Currently due to reduction of direct causes of maternal mortality increasing interest of scientists cause arterial thrombotic complications. Pregnancy-related stroke is a rare event, however, when it occurs, may be life threatening and there may be implications for management of the patient and delivery. The mechanisms and risk factors for ischemic stroke related to pregnancy and in women of childbearing age remain unclear. Pathogenesis of so severe complication in young women is not fully understood, however, there is a concept thrombosis or cerebral embolism, which can develop on the background of well-known population-based risk factors such as hypertension, metabolic syndrome, smoking, heart rhythm disorders, valvular heart disease or in relation to typical obstetric pathologies, such as preeclampsia, massive obstetrical bleeding, septic complications, amniotic fluid embolism. In recent years, there is increasing interest in the role of thrombophilia in the pathogenesis of ischemic stroke, however, data on this issue is
even more limited and contradictory than for venous thrombosis. Methods of prevention of recurrent stroke and strategies of pregnancy and delivery management in women with history of ischemic stroke are also contradictory.
even more limited and contradictory than for venous thrombosis. Methods of prevention of recurrent stroke and strategies of pregnancy and delivery management in women with history of ischemic stroke are also contradictory.
About the Authors
S. V. Akinshina
State Federal-Funded Educational Institution of Higher Vocational Training I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
A. D. Makatsariya
State Federal-Funded Educational Institution of Higher Vocational Training I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
V. O. Bitsadze
State Federal-Funded Educational Institution of Higher Vocational Training I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
References
1. Makacarija A.D., Beloborodova E.V., Bajmuradova S.M., Bicadze V.O. Gipergomocis teinemijaioslozhnenijaberemennosti. M. 2005; 216 s.
2. Makacarija A.D., Bicadze V.O., Bajmuradova S.M., Dolgushina N.V., Judaeva L.S., Hizroeva D.H., Akin'shina S.V. Antifosfolipidnyjsindrom – immunnajatrombofilii v akusherstveiginekologii. M. 2007; 456 s.
3. Bates S.M., Greer I.A., Pabinger I. et al.; American College of Chest Physicians. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008 Jun; 133 (6): 844-886.
4. Boekholdt S.M., Kramer M.H. Arterial thrombosis and the role of thrombophilia. Semin. Thromb. Hemost. 2007 Sep; 33 (6): 588-96.
5. Brey R.L. Antiphospholipid antibodies in young adults with stroke. J. Thromb. Thrombolysis. 2005 Oct; 20 (2):105-12.
6. Carbillon L. Pregnancy is an essential spontaneous screening stress test for the risk of early stroke in women. Stroke. 2008 Aug; 39 (8): 138.
7. Carlin A.J., Farquharson R.G., Quenby S.M. et al. Prospective observational study of bone mineral density during pregnancy: low molecular weight heparin versus control. Hum Reprod. 2004 May; 19 (5): 1211-4.
8. Chan W.S. Venous thromboembolism in pregnancy. Expert Rev Cardiovasc Ther. 2010 Dec; 8 (12): 1731-40.
9. Clark P., Greer I.A. Prevention and treatment of arterial thrombosis in pregnancy. Semin Thromb Hemost. 2003 Apr; 29 (2): 155-64.
10. Cojocaru I.M., Cojocaru M., Burcin C., Atanasiu A. Evaluation of antiphospholipid antibodies in young women with ischemic stroke. Rom. J. Intern. Med. 2007; 45 (2): 201-4.
11. Coomarasamy A., Honest H., Papaioannou S. et al. Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review. Obstet. Gynecol. 2003 Jun; 101 (6): 1319-32.
12. Coppage K.H., Hinton A.C., Moldenhauer J. et al. Maternal and perinatal outcome in women with a history of stroke. Amer. J. Obstet. Gynecol. 2004; 190 (5): 1331-34.
13. Coppola A., Tufano A., Cerbone A.M., Di Minno G. Inherited thrombophilia: implications for prevention and treatment of venous thromboembolism. Semin Thromb Hemost. 2009 Oct; 35 (7): 683-94.
14. Davie C.A., O'Brien P. Stroke and pregnancy. J. Neurol. Neurosurg. Psychiatry. 2008 Mar; 79 (3): 240-5.
15. Di Carlo A, Lamassa M, Baldereschi M et al; European BIOMED Study of Stroke Care Group. Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke. 2003 May; 34 (5): 1114-9.
16. Empson M., Lassere M., Craig J., Scott J. Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database Syst Rev. 2005 Apr 18; (2): CD002859.
17. Govindaiah V., Naushad S.M., Prabhakara K. et al. Association of parental hyperhomocysteinemia and C677T Methylene tetrahydrofolate reductase (MTHFR) polymorphism with recurrent pregnancy loss. Clin. Biochem. 2009 Mar; 42 (4-5): 380-6.
18. Greer I.A., Nelson-Piercy C. Low-molecularweight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood. 2005 Jul 15; 106 (2): 401-7.
19. Haywood S., Liesner R., Pindora S., Ganesan V. Thrombophilia and first arterial ischaemic stroke: a systematic review. Arch Dis. Child. 2005 Apr; 90 (4): 402-5.
20. Hills F.A., Abrahams V.M., Gonz lez-Tim n B et al. Heparin prevents programmed cell death in human trophoblast. Mol Hum Reprod. 2006 Apr; 12 (4): 237-43.
21. Huang T., Yuan G., Zhang Z. et al. Cardiovascular pathogenesis in hyperhomocysteinemia. Asia Pac. J. Clin Nutr. 2008; 17 (1): 8-16.
22. James A.H., Bushnell C.D., Jamison M.G. et al. Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet. Gynecol. 2005 Sep; 106 (3): 509-16.
23. Kitchens K.S., Alving B.M., Kessler C.M. Consultative haemostasis and thrombosis. Elsivier Science. 2002; 617 p.
24. Kittner S.J., Stern B.J., Feeser B.R. et al. Pregnancy and the risk of stroke. N. Engl. J. Med. 1996 Sep 12; 335 (11): 768-74.
25. Koniari I., Siminelakis S.N., Baikoussis N.G. et al. Antiphospholipid syndrome; its implication in cardiovascular diseases: a review. J. Cardiothorac. Surg. 2010 Nov 3; 5: 101.
26. Kupferminc M.J., Yair D., Bornstein N.M. et al. Transient focal neurological deficits during pregnancy in carriers of inherited thrombophilia. Stroke. 2000 Apr; 31 (4): 892-5.
27. Lalouschek W., Schillinger M., Hsieh K. et al. Matched case-control study on factor V Leiden and the prothrombin G20210A mutation in patients with ischemic stroke/transient ischemic attack up to the age of 60 years. Stroke. 2005 Jul; 36 (7): 1405-9.
28. Lamy C., Hamon J.B., Coste J., Mas J.L. Ischemic stroke in young women: risk of recurrence during subsequent pregnancies. French Study Group on Stroke in Pregnancy. Neurology. 2000; 55 (2): 269-74.
29. Martinelli I., Battaglioli T., Burgo I. et al. Oral contraceptive use, thrombophilia and their interaction in young women with ischemic stroke. Haematologica. 2006 Jun; 91 (6): 844-7.
30. Mehdi A.A., Uthman I., Khamashta M. Antiphospholipid syndrome: pathogenesis and a window of treatment opportunities in the future. Eur J. Clin Invest. 2010 May; 40 (5): 451-64.
31. Mello G., Parretti E., Fatini C. et al. Lowmolecular-weight heparin lowers the recurrence rate of preeclampsia and restores the physiological vascular changes in angiotensinonverting enzyme DD women. Hypertension. 2005 Jan; 45 (1): 86-91.
32. Ness R.B., Markovic N., Bass D. et al. Family history of hypertension, heart disease, and stroke among women who develop hypertension in pregnancy. Obstet. Gynecol. 2003 Dec; 102 (6):1366-71.
33. Nicolaides A.N., Breddin H.K., Carpenter P. et al. European Genetics Foundation; Cardiovascular Disease Educational and Research Trust; International Union of Angiology; Mediterranean League on Thromboembolism. Thrombophilia and venous thromboembolism. International consensus statement. Guidelines according to scientific evidence. Int. Angiol. 2005 Mar; 24 (1): 1-26.
34. Pezzini A., Grassi M., Iacoviello L., Del Zotto E et al. Inherited thrombophilia and stratification of ischaemic stroke risk among users of oral contraceptives. J. Neurol. Neurosurg. Psychiatry. 2007 Mar; 78 (3): 271-6.
35. Ray J.G., Vermeulen M.J., Schull M.J., Redelmeier D.A. Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study. Lancet. 2005 Nov 19; 366 (9499): 1797-803.
36. Roberts J.M., Cooper D.W. Pathogenesis and genetics of pre-eclampsia. Lancet. 2001 Jan 6; 357 (9249): 53-6.
37. Ros H.S., Lichtenstein P., Bellocco R et al. Pulmonary embolism and stroke in relation to pregnancy: how can high-risk women be identified? Am. J. Obstet. Gynecol. 2002 Feb; 186 (2): 198-203.
38. Sanson B.J., Lensing A.W., Prins M.H. et al. Safety of low-molecular-weight heparin in pregnancy: a systematic review. Thromb. Haemost. 1999 May; 81 (5): 668-72.
39. Segers O., Castoldi E. Factor V Leiden and activated protein C resistance. Adv. Clin. Chem. 2009; 49: 121-57.
40. Sibai B.M., Coppage K.H. Diagnosis and management of women with stroke during pregnancy/postpartum. Clin. Perinatol. 2004 Dec; 31 (4): 853-68.
41. Simioni P., Tormene D, Spiezia L. et al. Inherited thrombophilia and venous thromboembolism. Semin Thromb Hemost. 2006 Oct; 32 (7): 700-8.
42. Soriano D., Carp H., Seidman D.S. et al. Management and outcome of pregnancy in women with thrombophylic disorders and past cerebrovascular events. Acta Obstet. Gynecol. Scand. 2002 Mar; 81 (3): 204-7.
43. Szolnoki Z., Somogyvári F., Kondacs A. et al. Evaluation of the roles of the Leiden V mutation and ACE I/D polymorphism in subtypes of ischa emic stroke. J. Neurol. 2001 Sep; 248 (9): 756-61.
44. Tang C.H., Wu C.S., Lee T.H. et al. Preeclampsia-eclampsia and the risk of stroke among peripartum in Taiwan. Stroke. 2009 Apr; 40 (4): 1162-8.
45. Treadwell S.D., Thanvi B., Robinson T.G. Stroke in pregnancy and the puerperium. Postgrad Med. J. 2008 May; 84 (991): 238-45.
46. Urbanus R.T., Siegerink B., Roest M. et al. Antiphospholipid antibodies and risk of myocardial infarction and ischaemic stroke in young women in the RATIO study: a casecontrol study. Lancet Neurol. 2009 Nov; 8 (11): 998-1005.
47. Voetsch B., Damasceno B.P., Camargo E.C. et al. Inherited thrombophilia as a risk factor for the development of ischemic stroke in young adults. Thromb Haemost. 2000 Feb; 83 (2): 229-33.
48. Warkentin T.E. Heparin-induced thrombocytopenia. Hematol. Oncol. Clin. North. Am. 2007 Aug; 21 (4): 589-607.
49. Wiebers D.O. Ischemic cerebrovascular complications of pregnancy. Arch. Neurol. 1985 Nov; 42 (11): 1106-13.
50. Witlin A.G., Mattar F., Sibai B.M. Postpartum stroke: a twenty-year experience. Am. J. Obs tet. Gynecol. 2000 Jul; 183 (1): 83-8.
51.
52.
Review
For citations:
Akinshina S.V., Makatsariya A.D., Bitsadze V.O. PREGNANCY IN WOMEN WITH HISTORY OF ISCHEMIC STROKE AND THROMBOPHILIA. Obstetrics, Gynecology and Reproduction. 2014;8(1):15-25. (In Russ.)
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