Thromboembolism risk following recurrent miscarriage

Abstract

Normal pregnancy is associated with extensive changes in hemostasis such that the procoagulant effect becomes dominant. The evolutionary advantage of this hypercoagulability may be to counteract the inherent instability associated with hemochorial placentation, which is unique to human beings. However, overall, there is a four- to 10-fold increased thrombotic risk throughout gestation and the postpartum period. Certain inherited or acquired thrombophilic factors may predispose to arterial and/or venous thrombosis and have a possible association with pregnancy complications, including recurrent miscarriage (RM), which affects up to 5% of couples with childbearing desire. A subgroup of women with RM has been demonstrated to be in a prothombotic state before and after pregnancy. The long-term health implications of this hypercoagulability may imply an increased risk of ischemic heart disease. Moreover, the presence of antiphospholipid antibodies rather than thrombophilic genetic defects (i.e., factor V Leiden or prothrombin G202010A mutation) in patients with RM is a determinant of thrombotic events later in life, especially among those patients having also cardiovascular risk factors. This article highlights the thromboembolic risk in nonpregnant RM patients in different thrombophilic settings and the need for thromboprophylaxis among these patients.

Keywords::

• antiphospholipid antibodies
• antiphospholipid syndrome
• inherited thrombophilias
• pregnancy loss
• recurrent miscarriage
• thrombosis risk
• thromboembolism risk

Financial & competing interests disclosure

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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

Key issues

• • A subgroup of women with recurrent miscarriage (RM) has been demonstrated to be in a prothombotic state before pregnancy.

• • The long-term health implications of the hypercoagulability in RM patients may imply an increased risk of ischemic heart disease.

• • Women with a history of RMs should be investigated for possible inherited or acquired thrombophilic defects.

• • The presence of antiphospholipid antibodies rather than thrombophilic genetic defects (i.e., factor V Leiden or prothrombin G202010A mutation) in patients with RM is a determinant of thrombotic events later in life, especially among those patients having also cardiovascular risk factors.

• • Several studies suggest that RM antiphospholipid antibody-positive individuals should be risk-stratified according to traditional cardiovascular risk factors, which can be responsible for triggering acute thrombosis. It may seem that treatment and/or prevention of these thrombosis risk factors could be an important intervention to reduce arterial thrombosis as previously suggested.