TROMBOFILIA Y EMBARAZO

Abstract

INTRODUCTION: Thromboembolic disease is the main cause of maternal mortality in Developed countries. Gestation is an hypercoagulable state with a predisposition to thrombosis, even more if there is another risk factor as thrombophilia. Thrombophilia has also been related with other frequent complications, the so-called vascular placental complicatons (VPC), due to placental insufficiency. There is a lack of evidence in this subject because of the absence of well-designed clinical randomized trials. _x000D_ OBJECTIVES: This lack of evidence conducted us to the design of the TEAM Project. The main objectives were: 1. Establish the prevalence of thrombophilia in pregnancy-related thrombosis and VPC. 2. Evaluate the clinical management of these complications. 3. Determine effectiveness and security of treatments used in this scenarios. _x000D_ MATERIALS AND METHODS: Multicenter, multidisciplinary, prospective and observational study. We analysed 4 patient cohorts: 1. Thrombosis cohort, 2. thrombosis prophylaxis cohort, 3. VPC cohort, 4. VPC prophylaxis cohort. We developed an informatic registry for data collection. We study clinic characteristics, performance of thrombophilia screening and antithrombotic treatments used in each cohort. _x000D_ RESULTADOS: A total of 1032 episodes and 1000 patients were registered. Distribution of these episodes was: 57 (5.5%) thrombosis, 312 (30.2%) thrombosis prophylaxis, 368 (35.7%) VPC and 257 (24.9%) PVC prophylaxis. In the VPC groups pregnancy loss was the most frequent complication registered (65.5 and 94.2% respectively). Thrombophilia studies were made in 82.6% patients in VPC cohort and in 70.2% of thrombosis patients. Positive results were obtained in 47 and 59% of patients in thrombosis and thrombosis prophylaxis groups and in 21% of patients with VPC. In this group the most common defects found were high levels of FVIII, no-O ABO genotype, positive antiphospholipid antibodies and homocygosity for F12C46T polymorphism. Antithrombotic treatment was used in 85% of thrombosis prophylaxis episodes, mainly with low molecular weight heparins (LMWH), and in 77% of VPC prophylaxis episodes, mainly with LMWH and aspirin. Only two major hemorrhagic complications were registered. Treatment effectiveness could not be evaluated in thrombosis prophylaxis cohort because of a very low recurrence rate (0.32%). Prophylaxis with LMWH +/- aspirin was not related with a better pregnancy outcome in VPC prophylaxis group. _x000D_ CONCLUSIONES: Thrombophilia studies were made to most patients in this registry i all four cohorts. Results were different in patients with thrombosis and VPC. In this group we found a high prevalence of high levels of FVIII, positive antiphospholipid antibodies and homocygosity for F12C46T polymorphism. Most patients in VPC prophylaxis group with or without thrombophilia recieved LMWH +/- aspirin, but we did not find a benefit of these treatments. Further studies with more patients will be needed to confirm our findings.

Date of Award	14 Nov 2016
Original language	Spanish
Supervisor	Maria Amparo Santamaria Ortiz (Director)