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Weronska A, De la Morena-Barrio B, Goldman-Mazur S, De la Morena-Barrio ME, Padilla J, Miñano A, Garrido P, Treliński J, Potaczek DP, Szczepanek A, Undas A, Corral J, Wypasek E. Functional, biochemical, molecular and clinical characterization of antithrombin c.1157T>C (p.Ile386Thr), a recurrent Polish variant with a founder effect. Haematologica 2023; 108:2803-2807. [PMID: 37021543 PMCID: PMC10542824 DOI: 10.3324/haematol.2022.282459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023] Open
Affiliation(s)
- Anna Weronska
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | | | - Sarah Goldman-Mazur
- Department of Hematology, Cellular Therapy and Hemostaseology, Leipzig University Hospital, Leipzig, Germany
| | | | - José Padilla
- Regional Hemodonation Center, University of Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain
| | - Antonia Miñano
- Regional Hemodonation Center, University of Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain
| | - Pedro Garrido
- Regional Hemodonation Center, University of Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain
| | - Jacek Treliński
- Department of Hemostasis Disorders, Medical University of Lodz, Łódź, Poland
| | - Daniel Piotr Potaczek
- Translational Inflammation Research Division and Core Facility for Single Cell Multiomics, Medical Faculty, Philipps University of Marburg, Marburg, Germany; Center for Infection and Genomics of the Lung (CIGL), Universities of Gießen and Marburg Lung Center (UGMLC), Gießen, Germany; Bioscientia MVZ Labor Mittelhessen GmbH, Gießen, Germany
| | - Anita Szczepanek
- Institute of Archaeology and Ethnology, Polish Academy of Sciencies, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; John Paul II Hospital, Kraków, Poland
| | - Javier Corral
- Regional Hemodonation Center, University of Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain.
| | - Ewa Wypasek
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland; John Paul II Hospital, Kraków, Poland.
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Inherited antithrombin deficiency in pregnancy. THROMBOSIS UPDATE 2022. [DOI: 10.1016/j.tru.2021.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Treatment of Homozygous Type II Antithrombin Heparin-Binding Site Deficiency in Pregnancy. Case Rep Obstet Gynecol 2021; 2021:4393821. [PMID: 34513101 PMCID: PMC8433018 DOI: 10.1155/2021/4393821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/14/2021] [Indexed: 12/02/2022] Open
Abstract
Pregnancy is associated with an increased risk of venous thromboembolism (VTE). Previous VTE and severe thrombophilia are important risk factors. Our case was a 36-year-old woman, gravida 6, para 0, with antithrombin (AT) deficiency caused by a homozygous mutation in the heparin-binding site (HBS). Her history included seven prior VTEs, three early and two late pregnancy losses. She was prophylactically treated with both human plasma-derived AT concentrate (hpATC) and low molecular weight heparin (LMWH), resulting in a successful 6th pregnancy and a healthy live born baby. There is limited evidence and guidance on the management of AT deficiency in pregnancy. Dosing and monitoring of anticoagulants, alone or together with hpATC, must be based on individual risk assessment. The severity of clinical manifestations varies with the type of AT deficiency. Characterization of the AT mutation may aid in the decision-making process and optimize pregnancy outcomes.
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Nicholson M, Chan N, Bhagirath V, Ginsberg J. Prevention of Venous Thromboembolism in 2020 and Beyond. J Clin Med 2020; 9:jcm9082467. [PMID: 32752154 PMCID: PMC7465935 DOI: 10.3390/jcm9082467] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/18/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
Venous thromboembolism (VTE) is the third most common cause of vascular mortality worldwide and comprises deep-vein thrombosis (DVT) and pulmonary embolism (PE). In this review, we discuss how an understanding of VTE epidemiology and the results of thromboprophylaxis trials have shaped the current approach to VTE prevention. We will discuss modern thromboprophylaxis as it pertains to genetic risk factors, exogenous hormonal therapies, pregnancy, surgery, medical hospitalization, cancer, and what is known thus far about VTE in COVID-19 infection.
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Abstract
PURPOSE OF REVIEW This manuscript addresses the risks for venous thromboembolism (VTE) during pregnancy and the associated challenges of both diagnosis and treatment. RECENT FINDINGS The obstacles to diagnosis given lack of specificity of typical biomarkers to predict VTE in pregnancy, as well as the unique fetal and bleeding risks introduced by managing massive pulmonary embolism (PE) with thrombolytics or thrombectomy are highlighted. VTE during pregnancy and the postpartum window occurs at a 6-10-fold higher rate compared with age-matched peers and is a major cause of morbidity and mortality. Hypercoagulability persists for 6-8 weeks after delivery with the highest risk of PE being postpartum. The lack of randomized trials in pregnant women leads to variability in practice, which are largely based on expert consensus or extrapolation from non-pregnant cohorts. The standard treatment of VTE in pregnancy is anticoagulation with low molecular weight heparin (LMWH), which like unfractionated heparin does not cross the placenta and is not teratogenic. LMWH is preferred given the negligible risk for heparin-induced thrombocytopenia and osteoporosis, better bioavailability, and a predictive dose response. Depending on the severity of the VTE, additional treatments including thrombolysis, thrombectomy, inferior vena cava filter placement, or venous stenting may be used. Management requires balancing the competing bleeding and thrombotic risks during labor and delivery and factoring the impact of treatment on the fetus. A multidisciplinary team involving hematology, obstetrics, anesthesia, vascular medicine, and cardiology is critical for safe and timely management. The design and execution of prospective, randomized trials to specifically address optimal diagnosis and management are a top priority in obstetric hematology.
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Affiliation(s)
- Annemarie E Fogerty
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA.
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Tsikouras P, Christoforidou A, Bothou A, Deuteraiou D, Anthoulaki X, Chalkidou A, Zervoudis S, Galazios G. Overcoming heparin resistance in pregnant women with antithrombin deficiency: a case report and review of the literature. J Med Case Rep 2018; 12:169. [PMID: 29907123 PMCID: PMC6004088 DOI: 10.1186/s13256-018-1711-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background The risk of thromboembolic events during pregnancy in patients with antithrombin deficiency is increased. Preventing thromboembolic events during pregnancy in the case of antithrombin deficiency is still a matter of concern. Case presentation We present a case of a 19-year-old primigravida Greek Pomak woman, who was diagnosed as having congenital antithrombin deficiency. She had a history of recurrent miscarriages and a family history of thrombosis. She was managed with adjusted doses of low molecular weight heparin throughout her pregnancy, with regular anti-Xa and antithrombin level monitoring. Prior to delivery and for 4 days after delivery she received human antithrombin III concentrate. She delivered a small for gestational age baby with no other complications. She required an increased dose of heparin due to heparin resistance. Conclusions Antithrombin deficiency is associated with an increased risk of venous thromboembolic events with a 50% risk of thromboembolic events before the 50th year of life. It is a rare condition, so data concerning the optimal management during pregnancy are limited. The selection of patients who should receive low molecular weight heparin prophylaxis as well as dose intensity and monitoring are discussed. In our patient a conventional low molecular weight heparin dose proved to be inadequate at least at the laboratory level.
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Affiliation(s)
- Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupoli, Greece.
| | - Anna Christoforidou
- Department of Haematology, Democritus University of Thrace, Alexandroupoli, Greece
| | - Anastasia Bothou
- Department of Obstetrics and Mastology, Rea Hospital, Athens, Greece
| | - Dorelia Deuteraiou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupoli, Greece
| | - Xanthoula Anthoulaki
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupoli, Greece
| | - Anna Chalkidou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupoli, Greece
| | | | - Georgios Galazios
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupoli, Greece
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