生殖失败与血栓形成倾向：关联并不紧密，证据不足。

Reproductive Failure and Thrombophilia: Not Enough Evidence for a Tight Bond.

机构信息

Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece,

Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.

出版信息

Acta Haematol. 2022;145(2):170-175. doi: 10.1159/000520439. Epub 2021 Dec 8.

DOI:10.1159/000520439

PMID:34879375

Abstract

OBJECTIVES

The role of hereditary thrombophilia in reproductive failure (RF) is strongly debatable. In this retrospective single-center study, we analyzed pregnancy outcome in 175 women screened for thrombophilia after at least one event of RF.

RESULTS

The prevalence of thrombophilia in our cohort was 33.4%. Pregnancy survival curves were not different according to severity (log-rank, p = 0.302) or type of thrombophilia (log-rank, p = 0.532). In total, 81.7% of 175 subsequent pregnancies were proceeded with LMWH. Concomitant use of ASA was prescribed in 75 pregnancies according to physician choice. The primary endpoint was live birth rate (LBR) that succeeded in 152/175 next pregnancies (86.8%) and late obstetric complications (LOBC) which occurred in 17/175 next pregnancies (9.8%). In logistic regression analysis, neither the severity nor the type of thrombophilia was important for any pregnancy outcome (LBR or LOBC). Considering therapeutic interventions, the use of LMWH ± ASA was not related to LBR or LOBC. The only factor inversely related to LBR was age above the cutoff value of 35.5 years (p = 0.049).

CONCLUSIONS

Incidence of thrombophilia is increased among women with RF, but the severity or type of thrombophilia is not related to pregnancy outcome.

摘要

目的

遗传性血栓形成倾向在生殖失败（RF）中的作用存在很大争议。在这项回顾性单中心研究中，我们分析了在至少一次 RF 事件后筛查血栓形成倾向的 175 名女性的妊娠结局。

结果

我们队列中血栓形成倾向的患病率为 33.4%。根据严重程度（对数秩检验，p=0.302）或血栓形成倾向的类型（对数秩检验，p=0.532），妊娠生存曲线无差异。共有 175 例后续妊娠中 81.7%采用低分子肝素（LMWH）。根据医生的选择，75 例妊娠同时开具了阿司匹林（ASA）。主要终点是活产率（LBR），在 175 例后续妊娠中，有 152 例成功（86.8%），晚发性产科并发症（LOBC）发生在 17 例（9.8%）。在逻辑回归分析中，血栓形成倾向的严重程度或类型对任何妊娠结局（LBR 或 LOBC）均不重要。考虑到治疗干预，LMWH±ASA 的使用与 LBR 或 LOBC 无关。唯一与 LBR 呈负相关的因素是年龄超过 35.5 岁的截止值（p=0.049）。