Assessment and management of high-risk pregnancies in women with thrombophilia

[Dr.Vad]

Под таким названием появился обзор от Бреннера & соавт., в котором публикуется оценка тромботического риска у беременных и коррекция дозы НМГ (эноксапарина) в зависимости от степени этого риска. Такая тактика похоже позволяет донашивать беременность (всем интересующимся - вышлю копию на мейл - скидывайте через ЛС), а пока фрагменты оттуда:

Therefore, we would like to propose a novel scoring system for women with thrombophilia including standardization to evaluate severity of pregnancy outcomes, thrombotic history and type of thrombophilia.

The scoring system is composed of four major categories: obstetrical history, previous thromboembolic events, family history and type of thrombophilia. The questionnaire includes information on history of venous thromboembolism (deep vein thrombosis, pulmonary embolism, splanchnic, cerebral or other thromboses), major stroke, and the underlying clinical background which led to these events (idiopathic, pregnancy, use of oral contraceptives, immobilization, etc.). Higher scores are given to more significant locations and the nature of thrombotic and idiopathic onset. In addition, the patient is questioned for the possibility that one or more first degree relatives have suffered from thromboembolic events or gestational vascular complications.

The patient is offered a complete thrombophilia work-up which includes:, Factor V Leiden, prothrombin G20210A, Methylenetetrahydrofolate reductase (MTHFR) 677TT mutations, levels of proteins C, S, Antithrombin, factor VIII, homocysteine, titer of anticardiolipin and anti beta2GPI antibodies and lupus anticoagulant. Thrombophilic traits are scored relative to observed prothrombotic tendency during pregnancy with antithrombin and homozygous factor V Leiden scored highest as single traits. Combined thrombophilia also has a higher score, and is sub-classified as “combined moderate” (i.e. heterozygous for both factor V Leiden and prothrombin G20210A mutations) and “combined severe” (i.e. strong lupus anticoagulant and homozygous for factor V Leiden or Antithrombin deficiency).

A total score is achieved by summing the scores of the four categories of thrombosis, obstetrical, family histories and thrombophilia. Based upon the score achieved, pregnancy risk for an individual woman may be stratified into four levels of risk: low (score less-than-or-equals 5), intermediate (score 6–10), high (score 11–14) and extremely high (score greater-or-equal 15).

In order to examine the feasibility of this scoring system, we studied, retrospectively, 90 pregnancies that were followed at the Thrombosis and Hemostasis clinic at Rambam, Health Care Campus from 2002 to 2006.

Inclusion criteria were LMWH treated pregnancies for which all the information on thrombosis, obstetric complications and thrombophilia for the score was available. Pregnancies were monitored monthly by medical examination and by testing anti-Xa activity levels.

Out of the 90 LMWH treated pregnancies, successful pregnancy outcome with live newborn was achieved in 74 (82%) women, the majority were at intermediate risk (score 6–10) (Table 3). A significant correlation was found between the proposed score and LMWH dosages that were prescribed to this group of patients (r = 0.62, P < 0.0001) (Fig. 1). Of note, 16 women (18%) suffered pregnancy loss at 16 ± 7 (range 6–32) weeks of gestation. In this group, no correlation was found between score and LMWH dosages (r = 0.06, P = 0.8)....

Assessment and management of high-risk pregnancies in women with thrombophilia.
Sarig G, Vidergor G, Brenner B.
Blood Rev. 2009 Jan 7.