%0 Journal Article
%T Review of Management and Outcomes in Women with Thrombophilia Risk during Pregnancy at a Single Institution
%A Alhossain A. Khalafallah
%A Abdul-Rauf O. Ibraheem
%A Qiong Yue Teo
%A Abdul-Majeed AlBarzan
%A Ramanathan Parameswaran
%A Emily Hooper
%A Toly Pavlov
%A Amanda E. Dennis
%A Terry Hannan
%J ISRN Obstetrics and Gynecology
%D 2014
%R 10.1155/2014/381826
%X Pregnancy is a hypercoagulable state associated with an increased risk of venous thromboembolic disease (VTE). We retrospectively studied 38 Caucasian pregnant women with thrombophilia risk and compared their obstetric outcomes with a matched cohort without known thrombophilia risk during the period between January 2007 and December 2010. There were (2) cases with factor V Leiden, (6) prothrombin gene mutation, (1) antithrombin III deficiency, (2) protein C deficiency, (3) protein S deficiency, (10) MTHFR mutation, (7) anti-cardiolipin antibodies, and (1) lupus anticoagulant. Patients without thrombophilia who presented with recurrent unprovoked VTE were considered as high risk (6 cases). Most patients received anticoagulation (34/38) with aspirin only (6), enoxaparin (27), and warfarin (1). Twenty-six out of thirty-eight pregnant women (68.4%) with an increased risk of thrombophilia experienced one or more obstetric complications defined as hypertension, preeclampsia, placenta abruptio, VTE, and oligohydramnios, compared with 15 out of 40 (37.5%) pregnant women in the control group (OR 3.6; 95% CI 1.42, 9.21, ). The incidence of obstetric complications was significantly higher in the thrombophilia group compared to the controls. However, these complications were the lowest among patients who received full-dose anticoagulation. Our study suggests that strict application of anticoagulation therapy for thrombophilia of pregnancy is associated with an improved pregnancy outcome. The study was registered in the Australian and New Zealand Clinical Trials Registry under ACTRN12612001094864. 1. Introduction Pregnancy is associated with major physiological changes that affect coagulation and the fibrinolytic system [1¨C3]. An imbalance in this system leads to a hypercoagulable state and pregnant women are therefore at an increased risk of venous thromboembolic disease (VTE), especially if they are affected by an associated acquired or inherited thrombophilia [2¨C4]. There are two factors that may exaggerate this risk: the high-risk nature of the thrombophilia and a history of a previous unprovoked VTE [5, 6]. High-risk hereditary thrombophilia includes antithrombin deficiency, prothrombin gene mutation (PGM), and factor V Leiden (FVL), while the presence of lupus anticoagulant or anti-cardiolipin antibodies are considered as acquired risk factors [7, 8]. Furthermore, homozygosity or presence of a combination of thrombophilia factors will aggravate the VTE risk by certain fold [7¨C9]. Apart from the occurrence of VTE, maternal thrombophilia has also been variably
%U http://www.hindawi.com/journals/isrn.obgyn/2014/381826/