Thrombophilia and Pregnancy

Abstract

Background. Women with a predisposition to thrombosis (thrombophilia) during pregnancy develop pathological hypercoagulation, which can lead to early and late pregnancy losses. The most significant polymorphisms of thrombophilia genes include antithrombin III deficiency, protein C deficiency, Leiden mutation, hereditary hyperhomocysteinemia, and mutations of other clotting factors. In addition, several forms of thrombophilia are caused by hyperaggregation. Currently, heparin and its derivatives are considered the safest and most effective agents for the prevention and therapy of thrombosis. However, it is impossible to evaluate the efficacy of heparins using only standard methods (activated partial thromboplastin time, thrombin time, prothrombin time) and markers of intravascular coagulation activation (soluble fibrin-monomer complexes, D-dimer) due to their insufficient sensitivity. One of the new tests of qualitative and quantitative evaluation of the plasma coagulation system is thrombodynamics test, which allows to detect even minimal coagulation disturbances. Aim. The aim was to evaluate the use of the thrombodynamics test in women with first trimester pregnancy pathology. The authors aimed to show the high sensitivity of this test for the monitoring of treatment with low molecular weight heparins (LMWH). Methods. The study included 23 pregnant women with pregnancy pathology and/or history of thrombosis and threatening miscarriage in the first trimester. The women were aged 22-38 years (median age 30 years). The complex evaluation of the hemostatic system was performed using the thrombodynamics test. Results. LMWH therapy with the thrombodynamics monitoring was administered to 20 of 23 women. The statistically significant changes were observed only for thrombodynamics indices (p < 0.05). The total of 14 women delivered healthy children at 38-40 weeks (all patients received LMWH in the first trimester). Conclusion. The thrombodynamics test was the most reliable method of monitoring LMWH therapy, since it allows recording even minimal coagulation disturbances.