title: Obstetric complications and pregnancy-related venous thromboembolism: the effect of low-molecular-weight heparin on their prevention in carriers of factor V Leiden or prothrombin G20210A mutation.
abstract: Whether the administration of low-molecular-weight heparin (LMWH) during pregnancy is effective in preventing obstetric complications and pregnancy-related venous thromboembolism (VTE) in women who are carriers of factor V Leiden (FVL) and/or prothrombin variant G20210A (PTm) is controversial. This observational study investigated the possible efficacy of pharmacological treatment with LMWH ± aspirin (ASA) in pregnancy outcomes in 1,011 pregnancies of 416 women with thrombophilia (FVL and/or PTm). Most patients were chosen on the basis of previous obstetrical complications (36%), or because of familial or personal history of venous/arterial thromboembolism (28% and 18%, respectively); 74 patients (18%) were incidentally identified. The outcome was evaluated according to the type of treatment and of the period of pregnancy when the treatment was started. After adjustment for observation before and after diagnosis of thrombophilia, previous miscarriages and VTE, parity, age and centre, we observed that LMWH had a protective effect on miscarriages (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.29-0.94) and VTE (OR 0.05, 95% CI 0.01-0.21). ASA appeared to have no effect on the prevention of obstetric complications and VTE. A nested analysis performed in 116 women with two or more obstetric complications confirmed that the highest number of live births was recorded in the group under LMWH prophylaxis (OR 0.19, 95% CI 0.05-0.75). These results suggest that LMWH prophylaxis reduces the risk of obstetric complications in carriers of FVL and/or PTm, particularly in those with previous obstetric events. Furthermore, LMWH prophylaxis reduces the risk of pregnancy-related VTE.
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, 2nd Chair of Internal Medicine, University of Padua, Padua, Italy. daniela.tormene@unipd.it
authors.forename: Daniela
authors.initials: D
authors.lastname: Tormene
authors.forename: Elvira
authors.initials: E
authors.lastname: Grandone
authors.forename: Valerio
authors.initials: V
authors.lastname: De Stefano
authors.forename: Alberto
authors.initials: A
authors.lastname: Tosetto
authors.forename: Gualtiero
authors.initials: G
authors.lastname: Palareti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Margaglione
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Castaman
authors.forename: Elena
authors.initials: E
authors.lastname: Rossi
authors.forename: Angela
authors.initials: A
authors.lastname: Ciminello
authors.forename: Leila
authors.initials: L
authors.lastname: Valdrè
authors.forename: Cristina
authors.initials: C
authors.lastname: Legnani
authors.forename: Giovanni Luca
authors.initials: GL
authors.lastname: Tiscia
authors.forename: Valeria
authors.initials: V
authors.lastname: Bafunno
authors.forename: Sara
authors.initials: S
authors.lastname: Carraro
authors.forename: Francesco
authors.initials: F
authors.lastname: Rodeghiero
authors.forename: Paolo
authors.initials: P
authors.lastname: Simioni
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology / Q000235:genetics / Q000503:physiopathology / Q000517:prevention & control*; D000328:Adult; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D016022:Case-Control Studies; D004359:Drug Therapy, Combination; D005165:Factor V / Q000235:genetics; D005260:Female; D020022:Genetic Predisposition to Disease; D014644:Genetic Variation; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000235:genetics / Q000503:physiopathology; D011516:Prothrombin / Q000235:genetics / Q000378:metabolism*; D054556:Venous Thromboembolism / Q000150:complications / Q000188:drug therapy* / Q000235:genetics / Q000503:physiopathology; D055815:Young Adult
chemical_list: D006495:Heparin, Low-Molecular-Weight; C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin; D001241:Aspirin