National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusion Medicine, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic.
Center of Immunology in Martin, s.r.o., Martin, Slovak Republic.
Clin Appl Thromb Hemost. 2022 Jan-Dec;28:10760296211070004. doi: 10.1177/10760296211070004.
Low-molecular-weight heparin (LMWH) is suggested for thromboprophylaxis in pregnant women with previous venous thromboembolism (VTE. Anyway, there is only limited amount of studies evaluating the effect of LMWH on hemostatic parameters during pregnancy of patients with previous VTE and the need of secondary thromboprophylaxis. We therefore provide results of prospective and longitudinal assessment of changes in hemostasis in high-risk pregnant women at four times during pregnancy (T1-T4) and one time after the postpartum period (T5) used for individualized modification of thromboprophylaxis. In this study, the results of coagulation factor VIII (FVIII) and protein S (PS) activity, ProC Global ratio and anti-Xa activity were evaluated. Despite the thromboprophylaxis, an increased predisposition to thromboembolic complications was detected (significant increase in FVIII activity and decrease in PS function, ProC Global ratio not normalized even after the postpartum period - < .0001 between controls and T5 for PS and ProC Global). These results indicate that hemostasis may not be restored even 6 to 8 weeks after delivery and pose the question when is it safe to withdraw the anticoagulant thromboprophylaxis in high-risk patients with prior VTE.
低分子肝素（LMWH）被建议用于有静脉血栓栓塞（VTE）史的孕妇的血栓预防。然而，只有有限的研究评估了 LMWH 对有 VTE 史的患者在怀孕期间止血参数的影响，以及二次血栓预防的需求。因此，我们提供了前瞻性和纵向评估在怀孕的四个时间点（T1-T4）和一个产后时间点（T5）高危孕妇止血变化的结果，用于个体化修改血栓预防。在这项研究中，评估了凝血因子 VIII（FVIII）和蛋白 S（PS）活性、ProC Global 比值和抗 Xa 活性的结果。尽管进行了血栓预防，但仍检测到血栓栓塞并发症的易感性增加（FVIII 活性显著增加，PS 功能下降，即使在产后期间，ProC Global 比值也未恢复正常-PS 和 ProC Global 的 T5 与对照组之间 <.0001）。这些结果表明，即使在分娩后 6 至 8 周，止血功能也可能无法恢复，这就提出了一个问题，即对于有 VTE 病史的高危患者，何时安全停止抗凝血栓预防。
