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Pregnant women with thrombophilia at high risk for gestational VTE
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Women with severe thrombophilia demonstrated a high absolute risk for pregnancy-associated venous thromboembolism regardless of family history, researchers in Germany found.
Investigators recommend women with severe thrombophilia be considered for routine antenatal thromboprophylaxis.
“Limited data on the magnitude of the thrombosis risk associated with heritable thrombophilias and the interaction of risk factors has impeded the development of evidence-based risk stratification to guide thromboprophylaxis. Consequently, there is a lack of consensus on thromboprophylaxis in national and international guidelines,” Andrea Gerhardt, MD, PhD, of the department of hemostasis, hemotherapy and transfusion medicine at Heinrich Heine University Medical Centre in Dusseldorf, Germany, and colleagues wrote. “Therefore, assessment of the individual thrombotic risk during pregnancy and the puerperium is important to provide evidence-based thromboprophylaxis management.”
The researchers performed a retrospective study of women who experienced a first incidence of VTE during pregnancy or within 6 weeks postpartum (n = 243). The analysis included age-matched controls with at least one previous pregnancy and no history of VTE (n = 243).
The women with a history of VTE were sent to Dusseldorf University Medical Center for treatment or consultation between January 1990 and December 2008.
Among women aged 35 years and older, the individual probability of gestational VTE was 0.7% for heterozygous factor V Leiden mutation; 3.4% for homozygous factor V Leiden mutation; 0.6% for heterozygous prothrombin G20210A; 8.2% for factor V Leiden mutation and prothrombin G20210A combined; 9% for antithrombin deficiency; 1.1% for protein C deficiency; and 1% for protein S deficiency.
Among women aged younger than 35 years, the probability of gestational VTE was 0.5% for heterozygous factor V Leiden mutation; 2.2% for homozygous factor V Leiden mutation; 0.4% for heterozygous prothrombin G20210A; 5.5% for compound heterozygous factor V Leiden mutation and prothrombin G20210A; 6.1% for antithrombin deficiency; 0.7% for protein C deficiency; and 0.7% for protein S deficiency.
The results for both groups were independent of a family history of VTE.
“Unselected women with homozygous factor V Leiden mutation, compound heterozygous factor V Leiden mutation and prothrombin G20210A, or severe antithrombin deficiency have a high risk of pregnancy-associated thrombosis, particularly women aged [35 years or older],” Gerhardt and colleagues wrote. “We suggest that, even though general screening of thrombophilic risk factors in all pregnant women may be considered ideal to estimate individual risk, this is unlikely to be cost-effective; therefore women with additional risk factors may constitute the main focus for counseling and selected thrombophilia screening in pregnancy.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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