The effect of various types of antithrombotic medication on pregnancy outcome in patients with high risk inherited thrombophilias and previous placenta-mediated diseases

Medical Review (Med. pregled), 2023, 59(5), 43-49.

K. Neykova, V. Dimitrova

“Maichin Dom” State University Hospital – Sofia

Abstract. The presence of inherited thrombophilias (ITs) should not be considered as the only reasonable issue in order to undertake a “specific” action in pregnancy follow-up. Aim of the study. To analyze the effect of various types of antithrombotic medication (AM) on pregnancy outcome in patients with high risk IT and a history for previous placenta-mediated diseases (PMDs). Materials and Methods. We studied 84 pregnant patients with IT on AM because of previous episode of PMDs. We divided the patients in 3 groups, according to the type of applied AM – only with low-dose aspirin (SG-LDA) –5/84 (6%), only with low-molecular weight heparin (SG-LMWH) ‒ 43/84 (51.2%), and/or combined AM with LDA and LMWH (SG-LDA+LMWH) ‒ 36/84 (42.8%). In each of the SGs we studied the following indices: mean gestational age (g.a.) at birth, percentage of preterm birth (PB), percentage of C-section (CS) – overall percentage, and for fetal distress (FD), percentage of cases where termination of pregnancy (TOP) was necessary. We further divided the studied patients on various types of AM in other 3 subgroups – patients on high-risk IT on AM only with LDA (SG1-LDA) ‒ 1/25 (4.0%), AM only with LMWH (SG1-LMWH) – 13/25 (52.0%), and/or patients on combined AM with LDA and LMWH (SG1-LDA+LMWH) ‒ 11/25 (44.0%). Results. There was no significant difference in duration of pregnancy in patients with ITs and previous PMDs on various types of AM. The lowest percentage of PBs and CSs was observed in SG-LDA (20% and 60%, respectively) in comparison with SG-LMWH (39.02% and 95.3%, respectively) and SG-LDA+LMWH (60.6% and 91.7%, respectively). The lowest rate of PBs and CSs for FD in patients with high-risk ITs and previous PMDs was observed in SG1-LDA+LMWH. In patients with high-risk IT, the lowest frequency of comment indicators was observed in the combined SG1-LDA+LMWH. Conclusion. AM only with LDA proves to be the most effect type of therapy in patients with ITs and previous history of PMDs in terms of pregnancy outcome. Whether LDA should be added to AM with LMWH in patients with previous history of PMDs and proven HRIT, is a matter of further more detailed research and an object of future discussions.

Key words: placenta-mediated diseases, high risk inherited thrombophilias, antithrombotic medication, preterm birth, C-section

Address for correspondence: Konstantsa K. Neykova, MD, PhD, e-mail: neykovaconstantsa@yahoo.com