Preventing thrombophilia-related complications of pregnancy: an update

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.

Keywords::

• anticoagulants
• fetal loss
• intrauterine growth restriction
• placental abruption
• preeclampsia
• pregnancy
• prophylaxis
• thrombophilia
• venous thromboembolism

Financial & competing interests disclosure

SM Bates has received honoraria from Leo Pharma, Inc. (the manufacturer of tinzaparin, a low-molecular-weight heparin) and from Pfizer Canada (the manufacturer of dalteparin, another low-molecular-weight heparin). The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.