title: Inherited and acquired thrombophilias.
abstract: Thrombophilias represent an evolving story that continues to stir controversy for care providers and obstetrical patients. The predominant thrombophilic mutations include the factor V Leiden mutation, prothrombin gene mutation G20210A, methylene tetrahydrafolate reductase C667T, and deficiencies of the natural anticoagulants proteins C and S, and antithrombin. Prospective cohort studies have provided an accurate assessment of the risk of placenta-mediated complications posed by common inherited thrombophilic conditions. Acquired thrombophilic conditions consist of the antiphospholipid antibody syndrome (APAS) and hyperhomocysteinemia. Well-conducted, placebo-controlled, randomized trials have demonstrated no benefit of anticoagulation in women with recurrent pregnancy loss and inherited thrombophilia. The routine use of anticoagulation to prevent other placenta-mediated complications in the setting of inherited thrombophilia should be considered experimental until the results of adequate clinical trials are available. Heparin anticoagulation and antiplatelet therapies are the cornerstone of treatment of APAS in pregnancy.
authors.affiliation: 1High Risk Pregnancy Unit, University Hospital of Careggi, Florence, Italy.
authors.forename: Marianna Pina
authors.initials: MP
authors.lastname: Rambaldi
authors.forename: Federico
authors.initials: F
authors.lastname: Mecacci
authors.forename: Secondo
authors.initials: S
authors.lastname: Guaschino
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Paidas
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics*; D011446:Prospective Studies; D019851:Thrombophilia / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: abortion; abruption; acquired thrombophilia; adverse pregnancy outcome; fetal demise; inherited thrombophilia; intrauterine growth restriction; preeclampsia; pregnancy; thrombophilia