High-risk inherited thrombophilias and their impact on pregnant women on antithrombotic medication for previous placenta-mediated diseases

Bulgarian Medical Journal, 2023, 17(4), 53-60.

K. Neykova, V. Dimitrova

„Maychin Dom” State University Hospital, Department of Obstetrics and Gynecology, Medical Faculty, Medical University – Sofia

Abstract. The combination of factors, such as inherited thrombophilias (ITs) and a previous history of placenta-mediated diseases (PMDs), is a risk factor for their recurrence during the current pregnancy. Aim of the study: To analyze the frequency of high-risk ITs and their impact on patients with antithrombotic medication (AM) for previous PMDs. Material and Methods. The patients with high-risk ITs data were considered in separate subgroups according to the performed AM as follows: the subgroup only on AM with low-dose aspirin (LDA) – 1/5 (20.0%), the subgroup only on AM with low-molecular weight heparin (LMWH) – 13/43 (30.2%), and the subgroup on combined therapy both with LDA and LMWH – 11/36 (30.6%). Patients with low-risk ITs data were also considered in separate subgroups as follows: the subgroup on AM with LDA – 4/5 (80.0%), the subgroup on АМ with LMWH – 30/43 (69.8%), and the subgroup on combined AM (LDA + LMWH) – 25/36 (69.4%). Results. In pregnant women with evidence of high risk ITs, AM with LMWH significantly reduce the frequency of FM. Combined AM (LDA+LMWH) has a favorable effect in the cases of previous preeclampsia (PE). In patients with data on low-risk ITs, AM with LDA impacted favorably the cases with intrauterine growth restriction (IUGR). AM with LMWH (alone) impacts the cases of PE and FM. Combined AM has a beneficial effect in reducing the frequency of FM cases alone. Conclusion. Our results confirm categorically the statement that in AM on the occasion of previous PMDs, specification of the “type” of the inherited thrombophilias is required.

Key words: inherited thrombophilias, antithrombotic medication, preeclampsia, intrauterine growth restriction, intrauterine fetal demise, placental abruption, fetus mortus

Address for correspondence: D-r Konstantsa Kr. Neykova, PhD, University hospital “Maichin dom”, tel.: 00359887367900, e-mail: neykovaconstantsa@yahoo.com