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Camacho Sáez B, Martínez-Taboada VM, Merino A, Comins-Boo A, González-Mesones B, Del Barrio-Longarela S, Riancho-Zarrabeitia L, López-Hoyos M, Hernández JL. Impact of Inherited Thrombophilia in Women with Obstetric Antiphospholipid Syndrome: A Single-Center Study and Literature Review. Biomedicines 2024; 12:1174. [PMID: 38927381 PMCID: PMC11201097 DOI: 10.3390/biomedicines12061174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
Inherited thrombophilia (IT) has been implicated as a potential causal factor of adverse pregnancy outcomes (APOs), including recurrent miscarriage with and without the presence of antiphospholipid syndrome (APS). The aim of this study was to assess the prevalence and impact of IT on fetal-maternal outcomes and thrombotic risk in women within the spectrum of obstetric APS. Three hundred and twenty-eight women with APS-related obstetric morbidity ever pregnant were included. Of these, 74 met the APS classification criteria, 169 were non-criteria (NC)-APS, and 85 were seronegative (SN)-APS. Patients with other autoimmune diseases were excluded. APOs included early pregnancy loss, fetal death, preeclampsia, abruptio placentae, and preterm birth. Successful pregnancy was defined as the achievement of a live newborn. A literature search was also performed. The mean age of the overall group was 33.9 ± 5.3 years, and the patients were followed up for 35 (11-79) months. During the study period, there were 1332 pregnancies. Nearly 14% of the patients had an associated IT. IT patients more frequently received the standard-of-care (SoC) therapy. The presence of IT was not associated with worse maternal-fetal outcomes in patients treated with SoC treatment. Overall, IT patients had a lower frequency of newborns without treatment, especially those without definite APS. In addition, IT did not increase the risk of thrombosis during pregnancy or the postpartum period. A detailed analysis of the literature review identified only four publications related to our study and did not show conclusive evidence of the impact of IT on patients with obstetric APS. The group of women with APS-related obstetric morbidity and IT who did not receive treatment, especially those without definite APS, had a worse prognosis in terms of a live birth. However, with SoC therapy, the prognosis is similar in those patients without IT. The association of IT with APS does not seem to predispose to the development of thrombosis during pregnancy and/or the postpartum period.
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Affiliation(s)
- Blanca Camacho Sáez
- Division of Rheumatology, Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain; (B.C.S.); (V.M.M.-T.)
| | - Víctor M. Martínez-Taboada
- Division of Rheumatology, Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain; (B.C.S.); (V.M.M.-T.)
- Departamento de Medicina y Psiquiatría, Universidad de Cantabria, 39011 Santander, Spain;
| | - Ana Merino
- Division of Obstetrics and Gynecology, Hospital Marqués de Valdecilla, 39008 Santander, Spain; (A.M.); (S.D.B.-L.)
| | - Alejandra Comins-Boo
- Immunology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain;
| | - Belén González-Mesones
- Heamatology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain;
| | - Sara Del Barrio-Longarela
- Division of Obstetrics and Gynecology, Hospital Marqués de Valdecilla, 39008 Santander, Spain; (A.M.); (S.D.B.-L.)
| | | | - Marcos López-Hoyos
- Immunology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain;
- Departamento de Biología Molecular, Universidad de Cantabria, 39011 Santander, Spain
| | - José L. Hernández
- Departamento de Medicina y Psiquiatría, Universidad de Cantabria, 39011 Santander, Spain;
- Department of Internal Medicine, Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain
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Shan D, Li T, Tan X, Hu YY. Low-molecular-weight heparin and preeclampsia - does the sword cut both ways? Three case reports and review of literature. World J Clin Cases 2024; 12:1634-1643. [PMID: 38576748 PMCID: PMC10989419 DOI: 10.12998/wjcc.v12.i9.1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/03/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Low-molecular-weight heparins (LMWH) are the most commonly used anticoagulants during pregnancy. It is considered to be the drug of choice due to its safety in not crossing placenta. Considering the beneficial effect in the improvement of microcirculation, prophylactic application of LMWH in patients with preeclampsia became a trend. However, the bleeding risk related with LMWH in preeclampsia patients has seldomly been evaluated. This current study aimed to identify the potential risks regarding LMWH application in patients with preeclampsia. CASE SUMMARY Herein we present a case series of three pregnant women diagnosed with preeclampsia on LMWH therapy during pregnancy. All the cases experienced catastrophic hemorrhagic events. After reviewing the twenty-one meta-analyses, the bleeding risk related with LMWH seems ignorable. Only one study analyzed the bleeding risk of LMWH and found a significantly higher risk of developing PPH in women receiving LMWH. Other studies reported minor bleeding risks, none of these were serious enough to stop LMWH treatment. Possibilities of bleeding either from uterus or from intrabdominal organs in preeclampsia patients on LMWH therapy should not be ignored. Intensive management of blood pressure even after delivery and homeostasis suture in surgery are crucial. CONCLUSION Consideration should be given to the balance between benefits and risks of LMWH in patients with preeclampsia.
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Affiliation(s)
- Dan Shan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610000, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, Sichuan, China
| | - Tao Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610000, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, Sichuan, China
| | - Xi Tan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610000, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, Sichuan, China
| | - Ya-Yi Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610000, Sichuan Province, China
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Filip C, Covali R, Socolov D, Carauleanu A, Tanasa IA, Scripcariu IS, Ciuhodaru M, Butureanu T, Pavaleanu I, Akad M, Boiculese LV, Socolov R. The postpartum uterine ultrasonographic scale in assessment of uterine involution after cesarean section in treated thrombophilia pregnant patients at term. J Clin Lab Anal 2022; 36:e24645. [PMID: 36082463 PMCID: PMC9459266 DOI: 10.1002/jcla.24645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/22/2022] [Accepted: 07/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background Pregnancy is a prothrombotic condition which can be abnormally exaggerated in women with thrombophilia. Methods In a prospective study, patients who delivered at term, by cesarean section, between 1 October 2017 and 1 December 2021, who already had a diagnosis of thrombophilia before coming to our hospital, were included in the study group (n = 80). A similar number of nonthrombophilia patients (n = 80) without any history of thrombotic events, age‐ and para‐matched with the study group, were included in the control group. The postpartum uterine ultrasonographic scale (PUUS) values, in the first 24–48 h, were correlated with the patients' data. Results The P‐LCR (platelet large cell ratio), was significantly higher in the treated thrombophilia group (p = 0.042). There was no correlation between PUUS and complete blood count values, coagulation factors, maternal characteristics, or fetal outcomes, except for postpartum neutrophils (p = 0.047) and postpartum platelet count (p = 0.046). Conclusions Postpartum uterine involution was not significantly different, after cesarean section, between treated thrombophilia patients and nonthrombophilia patients. Involution correlated only with postpartum neutrophils and postpartum platelet count.
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Affiliation(s)
- Catalina Filip
- Department of Vascular Surgery, Faculty of Medicine Grigore T. Popa University of Medicine and Pharmacy Iasi Romania
| | - Roxana Covali
- Department of Radiology, Biomedical Engineering Faculty, Grigore T. Popa University of Medicine and Pharmacy Iasi Elena Doamna Obstetrics and Gynecology University Hospital Iasi Romania
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi Cuza Voda Obstetrics and Gynecology University Hospital Iasi Romania
| | - Alexandru Carauleanu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi Cuza Voda Obstetrics and Gynecology University Hospital Iasi Romania
| | - Ingrid Andrada Tanasa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi Cuza Voda Obstetrics and Gynecology University Hospital Iasi Romania
| | - Ioana Sadyie Scripcariu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi Cuza Voda Obstetrics and Gynecology University Hospital Iasi Romania
| | - Madalina Ciuhodaru
- Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi Elena Doamna Obstetrics and Gynecology University Hospital Iasi Romania
| | - Tudor Butureanu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi Elena Doamna Obstetrics and Gynecology University Hospital Iasi Romania
| | - Ioana Pavaleanu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi Elena Doamna Obstetrics and Gynecology University Hospital Iasi Romania
| | - Mona Akad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi Elena Doamna Obstetrics and Gynecology University Hospital Iasi Romania
| | | | - Razvan Socolov
- Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi Elena Doamna Obstetrics and Gynecology University Hospital Iasi Romania
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Stamou M, Intzes S, Symeonidou M, Bazntiara I, Bezirgiannidou Z, Pentidou A, Misidou C, Liapis K, Margaritis D, Kotsianidis I, Spanoudakis E. Reproductive Failure and Thrombophilia: Not Enough Evidence for a Tight Bond. Acta Haematol 2021; 145:170-175. [PMID: 34879375 DOI: 10.1159/000520439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The role of hereditary thrombophilia in reproductive failure (RF) is strongly debatable. In this retrospective single-center study, we analyzed pregnancy outcome in 175 women screened for thrombophilia after at least one event of RF. RESULTS The prevalence of thrombophilia in our cohort was 33.4%. Pregnancy survival curves were not different according to severity (log-rank, p = 0.302) or type of thrombophilia (log-rank, p = 0.532). In total, 81.7% of 175 subsequent pregnancies were proceeded with LMWH. Concomitant use of ASA was prescribed in 75 pregnancies according to physician choice. The primary endpoint was live birth rate (LBR) that succeeded in 152/175 next pregnancies (86.8%) and late obstetric complications (LOBC) which occurred in 17/175 next pregnancies (9.8%). In logistic regression analysis, neither the severity nor the type of thrombophilia was important for any pregnancy outcome (LBR or LOBC). Considering therapeutic interventions, the use of LMWH ± ASA was not related to LBR or LOBC. The only factor inversely related to LBR was age above the cutoff value of 35.5 years (p = 0.049). CONCLUSIONS Incidence of thrombophilia is increased among women with RF, but the severity or type of thrombophilia is not related to pregnancy outcome.
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Affiliation(s)
- Maria Stamou
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece,
| | - Stergios Intzes
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Marianthi Symeonidou
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioanna Bazntiara
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Zoe Bezirgiannidou
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Aikaterini Pentidou
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christina Misidou
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Liapis
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Margaritis
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioannis Kotsianidis
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Emmanouil Spanoudakis
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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