The management of thrombophilia during pregnancy: a Canadian survey.
OBJECTIVE
To determine current Canadian practice patterns in the management of pregnant women with thrombophilia.


METHODS
Physician members of the Society of Obstetricians and Gynaecologists of Canada (SOGC) who provide obstetrical care were invited to complete a closed-ended questionnaire in which they were presented 5 clinical scenarios involving thrombophilic pregnancies and asked to give their management recommendations. The 5 scenarios presented in the survey were of a pregnant woman with (1) asymptomatic factor V Leiden (FVL), (2) asymptomatic FVL and a family history of venous thromboembolism (VTE), (3) FVL and recurrent fetal loss, (4) FVL and a previous VTE, or (5) antiphospholipid antibody syndrome and recurrent fetal loss.


RESULTS
Of the 1448 eligible SOGC members invited, 18 had moved with no forwarding address, and 662 (46.3% of the remainder) responded. The majority (65%) of the respondents were obstetricians and 51% of them had a university-affiliated practice. In scenario 1, 26% of physicians indicated they would recommend some form of antepartum thromboprophylaxis, whereas in the remaining four scenarios, 58% to 84% would definitely recommend antepartum thromboprophylaxis.


CONCLUSIONS
Most clinicians favour intervening with thromboprophylaxis in pregnant thrombophilic women rather than observing without prophylaxis. This tendency spans a wide range of clinical scenarios, despite a lack of evidence to support such decisions. This survey highlights the need to provide clinicians and women with evidence for the safety and effectiveness of prophylaxis, before these interventions become the default recommendation by clinicians caring for this prevalent group of women.
Rodger
Marc A
MA
Department of Medicine, University of Ottawa, Ottawa, ON.
Carrier
Marc
M
Keely
Erin
E
Karovitch
Alan
A
Nimrod
Carl
C
Walker
Mark
M
Wells
Philip S
PS
D000026:Abortion, Habitual; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000188:drug therapy; D002170:Canada; D005165:Factor V; D005260:Female; D006801:Humans; D009774:Obstetrics / Q000379:methods*; D010820:Physicians; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000628:therapy*; D011795:Surveys and Questionnaires; D019851:Thrombophilia / Q000188:drug therapy*; D013927:Thrombosis / Q000517:prevention & control; D020246:Venous Thrombosis / Q000150:complications / Q000235:genetics
D000925:Anticoagulants; C095381:factor V Leiden; D005165:Factor V