Preventing Thrombophilia-Related Complications of Pregnancy
Preventing Thrombophilia-Related Complications of Pregnancy
Approximately half of all pregnancy-related venous thromboembolic events are associated with thrombophilia. Although the most compelling data for a link between thrombophilia and other adverse pregnancy outcomes derive from women with antiphospholipid antibodies, some studies also suggest an association between these pregnancy complications and hereditary thrombophilias. Management of thrombophilia often involves anticoagulant therapy; however, use of these agents during pregnancy is challenging. There is a paucity of high-quality studies and consequently, recommendations are based largely on extrapolation from data in nonpregnant women, in addition to observational studies and a few small randomized studies. This article will review the impact of the thrombophilias on pregnancy and its outcome, evidence for therapies aimed at the prevention of thrombophilia-related pregnancy complications, and the most recent recommendations contained in the 9th Edition of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
Thrombophilias are associated with an increased risk of pregnancy-related venous thromboembolism (VTE) and may also be linked to placental-mediated pregnancy outcomes, such as fetal loss. Management of thrombophilia often involves anticoagulant therapy; however, use of these agents during pregnancy is challenging. Although evidence-based guidelines for the management of thrombophilia in pregnancy have been published, given the paucity of high-quality studies, recommendations are based largely on extrapolation from data in nonpregnant women, in addition to observational studies and a few small randomized studies.
Abstract and Introduction
Abstract
Approximately half of all pregnancy-related venous thromboembolic events are associated with thrombophilia. Although the most compelling data for a link between thrombophilia and other adverse pregnancy outcomes derive from women with antiphospholipid antibodies, some studies also suggest an association between these pregnancy complications and hereditary thrombophilias. Management of thrombophilia often involves anticoagulant therapy; however, use of these agents during pregnancy is challenging. There is a paucity of high-quality studies and consequently, recommendations are based largely on extrapolation from data in nonpregnant women, in addition to observational studies and a few small randomized studies. This article will review the impact of the thrombophilias on pregnancy and its outcome, evidence for therapies aimed at the prevention of thrombophilia-related pregnancy complications, and the most recent recommendations contained in the 9th Edition of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
Introduction
Thrombophilias are associated with an increased risk of pregnancy-related venous thromboembolism (VTE) and may also be linked to placental-mediated pregnancy outcomes, such as fetal loss. Management of thrombophilia often involves anticoagulant therapy; however, use of these agents during pregnancy is challenging. Although evidence-based guidelines for the management of thrombophilia in pregnancy have been published, given the paucity of high-quality studies, recommendations are based largely on extrapolation from data in nonpregnant women, in addition to observational studies and a few small randomized studies.