Monitoring of Hemostasis and Management of Anticoagulant Thromboprophylaxis in Pregnant Women with Increased Risk of Fetal Loss.
Physiological prothrombotic changes during pregnancy and the postpartum period, along with other preexisting maternal risk factors, increase the risk of both venous thromboembolism (VTE) and adverse pregnancy outcomes. Pregnancy complications that develop due to placental insufficiency as a result of inappropriate activation of coagulation are present in more than 5% of pregnancies and can contribute to significant maternal morbidity and mortality. Therefore, anticoagulant prophylaxis in women with congenital and acquired thrombophilic conditions should be actively considered. According to the Guidelines of American College of Chest Physicians, the use of low-molecular-weight heparin is suggested for prophylaxis of VTE and pregnancy complications in high-risk pregnant women. However, personalized refinements of such thromboprophylaxis remains unspecified, despite the necessity of better targeted recommendations for life-threatening conditions. We, therefore, review the possibilities of longitudinal monitoring and comprehensive assessment of changes in hemostasis in the group of high-risk pregnant women, which can then be used for early prediction and individualization of the optimal anticoagulant thromboprophylaxis of pregnancy complications. Simultaneously, we present our single-center experience with such monitoring and our first series of results.
National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic.
Lucia
L
Stanciakova
National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic.
Miroslava
M
Dobrotova
National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic.
Zuzana
Z
Jedinakova
National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic.
Lukas
L
Duraj
National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic.
Ingrid
I
Skornova
National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic.
Lubica
L
Korinkova
National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic.
Pavol
P
Holly
Clinic of Gynecology and Obstetrics, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital in Martin, Martin, Slovak Republic.
Jan
J
Danko
National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic.
Jan
J
Stasko
National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic.
Peter
P
Kubisz
D000022:Abortion, Spontaneous / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D010927:Placental Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D011247:Pregnancy; D012307:Risk Factors; D013923:Thromboembolism / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight