Kosar Ali, Kasapoglu Benan, Kalyoncu Senol, Turan Hakan, Balcik Ozlem S, Gümüs Emine I
Internal Medicine Department, Fatih University Hospital, Ankara, Turkey.
Blood Coagul Fibrinolysis. 2011 Jan;22(1):14-8. doi: 10.1097/MBC.0b013e32834013f2.
Inherited thrombophilia may cause important complications in pregnancies including maternal death, early and late pregnancy loss, preeclampsia, intrauterine growth restriction and placental abruption. This study was developed to investigate the fetal loss and successful birth rates in hereditary thrombophilic patients treated with low-dose acetylsalicylic acid and low molecular weight heparin to determine the necessity and effectiveness of this treatment. Ninety-three patients with the history of recurrent pregnancy loss or thromboembolism were included in this study. Eighty milligram acetylsalicylic acid treatment was started just after the diagnosis for the patients with hereditary thrombophilia, continued throughout pregnancy and ceased 3 days before the delivery. Low molecular weight heparin (LMWH) was started for the patients with the unsuccessful in-vitro fertilization (IVF) history, just after finishing the egg collection. For the other patients, LMWH was started after the positive result of the pregnancy test. Treatment was started for 67 (72%) of patients. Among the treated 67 patients, 38 had MTHFR C677T gene mutation, 25 had protein S deficiency, 19 had FV Leiden mutation, four had protein C deficiency, two had Prothrombin 20210A gene abnormality, two had antiphospholipid anticore syndrome and two had AT III deficiency. Fifty-seven (85.1%) of 67 patients under treatment had pregnancy. Forty-one (61.2%) of those 57 patients had a live birth, whereas 16 (23.9%) of them had abortus under treatment. In regression analysis, only protein C and S deficiencies were found to be independent risk factors. In conclusion, inherited thrombophilia should always be kept in mind as an etiological factor of recurrent abortus. With treatment, success rates are between 60 and 80%. Severe side effects due to treatment are rare. But randomized, double-blind, placebo-controlled studies are still necessary to evaluate the benefit of heparin and acetylsalicylic acid treatment in women with the history of inherited thrombophilia.
遗传性血栓形成倾向可能在妊娠中导致重要并发症，包括孕产妇死亡、早期和晚期流产、先兆子痫、胎儿生长受限和胎盘早剥。本研究旨在调查接受低剂量乙酰水杨酸和低分子量肝素治疗的遗传性血栓形成倾向患者的胎儿丢失率和成功出生率，以确定该治疗的必要性和有效性。本研究纳入了93例有复发性流产或血栓栓塞病史的患者。对于遗传性血栓形成倾向患者，在诊断后即开始80毫克乙酰水杨酸治疗，整个孕期持续使用，分娩前3天停药。对于有体外受精（IVF）失败病史的患者，在取卵结束后即开始使用低分子量肝素（LMWH）。对于其他患者，在妊娠试验呈阳性后开始使用LMWH。67例（72%）患者开始治疗。在接受治疗的67例患者中，38例有MTHFR C677T基因突变，25例有蛋白S缺乏，19例有FV Leiden突变，4例有蛋白C缺乏，2例有凝血酶原20210A基因异常，2例有抗磷脂抗核心抗体综合征，2例有抗凝血酶III缺乏。67例接受治疗的患者中有57例（85.1%）怀孕。这57例患者中有41例（61.2%）活产，而其中16例（23.9%）在治疗期间流产。在回归分析中，仅发现蛋白C和S缺乏是独立危险因素。总之，遗传性血栓形成倾向应始终被视为复发性流产的病因。通过治疗，成功率在60%至80%之间。治疗引起的严重副作用很少见。但仍需要进行随机、双盲、安慰剂对照研究，以评估肝素和乙酰水杨酸治疗对有遗传性血栓形成倾向病史女性的益处。
