ANTITHROMBOTIC PROPHYLAXIS REPEATED PREECLAMPSIA IN PATIENTS WITH THROMBOPHILIA
Abstract
Objective. To evaluate the efficiency of antithrombotic therapy to prevent repeated preeclampsia in patients with thrombophilia. Subject and methods. A prospective clinical study was conducted 66 patients with thrombophilia (genetic, acquired or concomitant) and with history of preeclampsia: 35 patients addressed and were followed since fertile cycle (subgroup Ia) and 31 patients addressed during pregnancy and were followed since 6-13 weeks of gestation – IIa subgroup. Control group – 50 patients without both obstetrics and gynecology and thrombotic complications in history. Therapy included LMWG (klexan), B vitamins, antioxidants and micronized progesterone. Results. The all period of pregnancy, obstetric and perinatal outcomes were better in patients receiving therapy since fertile cycle compared with group of patients whose therapy was initiated during pregnancy.Conclusion. To prevent re-PE at a subsequent pregnancy, the therapy should be start since fertile cycle, continuing during pregnancy, childbirth and the postpartum period. Therapy should include LMWH, B vitamins, antioxidants and micronized progesterone.
About the Author
E. V. Zhuravleva
First Moscow State Medical Sechenov University of the Ministry of Health Russian Federation
Russian Federation
Russian Federation
References
1. Baimuradova S.M. Patogenez, printsipy diagnostiki, profilaktiki i terapii sindroma poteri ploda, obuslovlennogo priobretennymi i geneticheskimi defektami gemostaza. Dis. ... dokt. med. nauk. Doct, Diss. (Pathogenesis, principles of diagnosis, prevention and treatment of the syndrome of fetal loss due to genetic defects and acquired hemostasis). Dr. diss. Moscow. 2007; 396 s.
2. Bitsadze V.O. Patogenez, printsipy diagnostiki i profilaktiki oslozhnenii beremennosti, obuslovlennykh trombofiliei. Dis. ... dokt. med. nauk. Doct, Diss. (Pathogenesis, principles of diagnosis and prevention of complications of pregnancy, due to thrombophilia). Dr. diss. Moscow. 2004; 251 s.
3. Makatsariya A.D., Bitsadze V.O., Akin’shina S.V. Thrombosis and thromboembolism in obstetric practice [Tromboz i tromboembolii v akushersko-ginekologicheskoi praktike]. 2007; 151 s.
4. Makatsariya A.D., Bitsadze V.O., Smirnova L.M., Akin’shina S.V., Baimuradova S.M. Thrombohemorrhagic complications in obstetric practice. Guidance for doctors [Trombogemorragicheskie oslozhneniya v akushersko-ginekologicheskoi praktike. Rukovodstvo dlya vrachei]. Moscow. 2011; 1056 s.
5. Alfirevic Z., Roberts D. et al. How strong is the association between maternal thrombophilia and adverse pregnancy outcomes. A systematic review. Eur. J. Obstet. Gyn. Reprod. Biol. 2002; 101 (1): 6-14.
6. Brenner B., Hoffman R., Blumenfeld Z. et al. Gestational outcome in thrombophilic women with recurrent pregnancy loss treated by enoxaparin. Thromb. Haemost. 2000 May; 83 (5): 693-7.
7. Cervera R., Piette J.C., Font J. et al. EuroPhospholipid Project Group. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum. 2002. Apr; 46 (4): 1019-27.55.
8. Dossenbach-Glaninger A., van Trotsenburg M.,Dossenbach M. et al. Plasminogen activator inhibitor 1 4G/5G polymorphism and coagulation factor XIII Val34Leu polymorphism: impaired fibrinolysis and early pregnancy loss. Clin. Chem. 2003 Jul; 49 (7): 1081-6.
9. Gris J.C., Mercier E., Quéré I. et al. Lowmolecular-weight heparin versus lowdose aspirin in women with one fetal loss and a constitutional thrombophilic disorder. Blood. 2004 May 15; 103 (10): 3695-9.
10. Kovac M., Mitic G. et al. Thrombophilia in women with pregnancy-associated complications: fetal loss and pregnancy-related venous thromboembolism. Gynecol. Obstet. Invest. 2010; 69 (4): 233-8.
11. Kupferminc M.J. Thrombophilia and pregnancy. Reprod. Biol. Endocrinol. 2003; 1:111.
12. Lyall Fiona, Belfort Michael, editors.Preeclampsia. Etiology and clinical practice. Cambridge, UK. 2007.
13. Main E.K. Maternal mortality: new strategies for measurement and prevention. Curr. Opin. Obstet. Gynecol. 2010 Dec; 22 (6): 511-6.
14. National Institute for Clinical Excellence. Why Women die. Report on Confidential Enquiries into Maternal Deaths in the United Kingdom, 1997-1999. London. 2001.
15. Pandey M., Mantel G.D., Moodley J. Audit of severe acute morbidity in hypertensive pregnancies in a developing country. J. Obstet. Gynecol. 2004; 24: 387-391.
16. Saving Mothers. Third Report on Confidential Enquiries into Maternal Deaths in South Africa 2002-2004. Department of Health, Pretoria.
17. Villar J., Abalos E., Nardin J.M., Merialdi M., Carroli G. Strategies to prevent and treat preeclampsia: evidence from randomized controlled trials. Semin. Nephrol. 2004; 24 (6): 607-15.
18.
19.
For citation:
Zhuravleva E.V. ANTITHROMBOTIC PROPHYLAXIS REPEATED PREECLAMPSIA IN PATIENTS WITH THROMBOPHILIA. Obstetrics, Gynecology and Reproduction. 2014;8(2):11-16. (In Russ.)
Views: 106
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 