%0 Journal Article
%T The Role of Thrombophilia in Pregnancy
%A Elisabeth M. Battinelli
%A Ariela Marshall
%A Jean M. Connors
%J Thrombosis
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/516420
%X Thrombotic disease is a major cause of peripartum morbidity and mortality worldwide. Development of thrombosis in pregnancy is multifactorial due to the physiologic changes of pregnancy¡ªwhich induce a relative hypercoagulable state¡ªas well as physical changes leading to increased stasis and also the effects of both the inherited and the acquired thrombophilias. In this review, we discuss the impact of each of these factors on the development of thrombosis as well as the evidence for the impact of pregnancy-associated thrombosis on pregnancy outcome. We then discuss the use of both prophylactic and therapeutic anticoagulation during pregnancy and the puerperium. We review the indications and dosing recommendations for administration of anticoagulation in a context of discussing the evidence including the lack of evidence and formal guidelines in this area. We briefly address the role of the new oral anticoagulants in pregnancy and conclude that significant further research in women with thrombophilias and pregnancy-associated thrombosis may help clarify the management of this condition in the future. 1. Introduction The risk of venous thromboembolic events (VTE) is high during pregnancy due to both physiologic changes of pregnancy and the additional impact of the inherited and acquired thrombophilias. The overall rate of venous thromboembolic events in pregnancy is 200 per 100,000 deliveries [1]. The main risk appears to occur in the postpartum period where the incidence increases almost 2.5-fold and is estimated at 500 per 100,000. The majority of these events are deep vein thrombosis as opposed to the more deadly pulmonary embolism. Venous thromboembolic events remain a leading cause of death which has been estimated to range from 1.2 to 4.7 per 100,000 pregnancies. Inherited and acquired thrombophilias contribute further to an increased predisposition to thrombotic events. The overall impact of the inherited and acquired thrombophilias is low in the nonpregnant population, and the majority of patients never experience a thrombotic event. During pregnancy, however, the increased risk of thromboses in patients with inherited and acquired thrombophilias can be substantial and warrants consideration, especially as thrombosis is the leading cause of mortality during pregnancy. Fifty percent of the patients with thrombosis during pregnancy will be found to have an underlying thrombophilia. 2. Pathophysiologic Changes during Pregnancy The physiological changes that occur during pregnancy are mainly responsible for the increased thrombogenicity of the
%U http://www.hindawi.com/journals/thrombosis/2013/516420/