Clinical Study on Prophylactic and Therapeutic Management of Thrombophilia in Adverse Pregnancy Outcome Patients
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 5
Abstract
Background: There is a growing view that inherited and acquired thrombophilia may predispose to adverse pregnancy outcome (APO). APOs such as pregnancy loss, preeclampsia, and intrauterine growth retardation (IUGR) are associated with thrombotic mechanisms and thrombophilia, vice versa. The use of low-molecular-weight heparin (LMWH) has been studied in women with previous APO; however, the reports are inconsistent. This may be due to heterogeneity of the study groups and insufficient classification of the entire disease processes to guide the treatment guidelines. It is also due to the variation in gestational age at the start-up of LMWH treatment which is equally important. In the absence of other effective treatments and its accepted safety in pregnancy, LMWH was used in this study to analyze the results. Aim of the Study: This study aims to evaluate the overall efficacy of LMWH and low-dose aspirin in the management of thrombophilia. Materials and Methods: A total of 69 patients with a history of APO with thrombophilia were included to evaluate the overall efficacy of LMWH and low-dose aspirin in their management. Thrombophilic studies done: Anticardiolipin antibodies test, lupus anticoagulant test, protein C assay, protein S assay, activated protein C-resistant test, antithrombin assay, homocysteine estimation, prothrombin gene mutation test, anti--2 glycoprotein antibodies assay, proglobal C assay, and factor V Leiden mutation test. American College of Obstetricians and Gynecologists guidelines were applied in planning the treatment of patients consisting of dalteparin (fragmin) and low-dose aspirin. Both symptomatic (prophylaxis) and asymptomatic (therapeutic) patients with a history of previous APO were treated; dose was adjusted on regular evaluation of activated partial thromboplastin time, creatinine clearance (Cr Cl <30 mL/min), and an International Normalized Ratio 2.0–3.0. All the data were analyzed using standard statistical methods. Observations and Results: A total of 69 patients with a history of APO were screened for inherited and acquired thrombophilia. The patients were enrolled over a period of 2 years from July 2006 to June 2008 from the OPD at the Department of Obstetrics and Gynaecology, AIIMS, New Delhi. Recurrent abortion in 32 (46.37%) patients was the most common APO in women screened for thrombophilia. Other indications were IUGR in 11 (15.94%), severe preeclampsia in 9 (13.04%), and unexplained intrauterine device in 17 (24.63%) patients. 45/69 patients were treated for thrombophilia. 2/45 patients had to undergo termination of pregnancy; hence, 43 cases were tabulated for analysis in this study. 21/43 (48.83%) were asymptomatic and 22/45 were (51.16%) symptomatic patients with active thrombophilic symptoms and signs. In asymptomatic type of thrombophilia, the live birth rate was 86.87%, and in symptomatic type, it was 90. 97% and both the results were significant statistically with P value of 0.010 and 0.001, respectively (P taken as significant at P < 0.05). Continuation of pregnancy beyond 37 weeks in asymptomatic group was 76.19% and in symptomatic group 68.18%. The results were significant with P values at 0.024. In the asymptomatic group, 15/21 newborns weight (71.42%) was >2.5 kg compared to 4/21 (19.045) with weight <2.5 kg and P = 0.031, significant. Among the newborns of symptomatic group, 14/22 (63.63%) were >2.5 kg and 7/22 (31.81%) were below, with P = 0.040 and significant. Conclusions: The management of thrombophilia in the setting of pregnancy remains controversial. LMWH and aspirin provide benefit, both as prophylactic and therapeutic treatment for asymptomatic and symptomatic thrombophilia. However, prophylactic anticoagulation should be addressed on a case-by-case basis taking into account the inherited and acquired thrombophilias and history of prior pregnancies and their outcomes. Women with acquired thrombophilia are more likely to benefit from anticoagulation and should be treated according to published guidelines.
Authors and Affiliations
S Sooraj
Keywords
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