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Systemic Thromboembolism in Pregnancy: Heritable and Acquired Thrombophilias

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Abstract

Normal pregnancy is a hypercoagulable state. The predisposition to thrombosis may be exacerbated in women with heritable or acquired predisposition to thrombosis, known as thrombophilia. For a variety of reasons, the precise contribution of these thrombophilias to pregnancy morbidity is uncertain. However, there is evidence of an association between heritable thrombophilia and pregnancy morbidity including early and late pregnancy loss, preeclampsia, and intrauterine growth restriction. There also appears to be a weak association with placental abruption. Management of pregnant women with a thrombophilia relies on an accurate assessment of individual risk based on her personal and family history.

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References

  1. Rosendaal FR. Venous thrombosis: a multicausal disease. Lancet. 1999;353:1167–73.

    Article  CAS  PubMed  Google Scholar 

  2. Langdown J, Johnson DJ, Baglin TP, Huntington JA. Allosteric activation of antithrombin critically depends upon hinge region extension. J Biol Chem. 2004;279:47288–97.

    Article  CAS  PubMed  Google Scholar 

  3. Gopel W, Ludwig M, Junge AK, Kohlmann T, Diedrich K, Moller J. Selection pressure for the factor-V-Leiden mutation and embryo implantation. Lancet. 2001;358:1238–9.

    Article  CAS  PubMed  Google Scholar 

  4. Lisman T, de Groot PG, Meijers JC, Rosendaal FR. Reduced plasma fibrinolytic potential is a risk factor for venous thrombosis. Blood. 2005;105:​1102–5.

    Article  CAS  PubMed  Google Scholar 

  5. Meltzer ME, Lisman T, Doggen CJ, de Groot PG, Rosendaal FR. Synergistic effects of hypofibrinolysis and genetic and acquired risk factors on the risk of a first venous thrombosis. PLoS Med. 2008;5:e97.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Bezemer ID, Doggen CJ, Vos HL, Rosendaal FR. No association between the common MTHFR 677C->T polymorphism and venous thrombosis: results from the MEGA study. Arch Intern Med. 2007;167:​497–501.

    Article  CAS  PubMed  Google Scholar 

  7. Brown K, Luddington R, Baglin T. Effect of the MTHFRC677T variant on risk of venous thromboembolism: interaction with factor V Leiden and prothrombin (F2G20210A) mutations. Br J Haematol. 1998;103:42–4.

    Article  CAS  PubMed  Google Scholar 

  8. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, Derksen RHWM, de Groot PG, Koike T, Meroni PL, Reber G, Shoenfeld Y, Tincani A, Vlachoyiannopoulos PG, Krilis SA. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295–306.

    Article  CAS  PubMed  Google Scholar 

  9. Pengo V, Tripodi A, Reber G, Rand JH, Ortel TL, Galli M, De Groot PG. Update of the guidelines for lupus anticoagulant detection. J Thromb Haemost. 2009;7:1737–40.

    Article  CAS  PubMed  Google Scholar 

  10. Baglin T, Gray E, Greaves M, Hunt B, Keeling D, Machin S, Mackie I, Makris M, Nokes T, Perry D, Tait RC, Walker I, Watson H. Clinical guidelines for testing for heritable thrombophilia Br J Haematol. 2010;149:209–20

    Google Scholar 

  11. Baglin T. Unravelling the thrombophilia paradox: from hypercoagulability to the prothrombotic state. J Thromb Haemost. 2010;8:228–33.

    Article  CAS  PubMed  Google Scholar 

  12. Rosendaal FR, Bovill EG. Heritability of clotting factors and the revival of the prothrombotic state. Lancet. 2002;359:638–9.

    Article  CAS  PubMed  Google Scholar 

  13. Robertson L, Wu O, Langhorne P, Twaddle S, Clark P, Lowe GD, Walker ID, Greaves M, Brenkel I, Regan L, Greer IA. Thrombophilia in pregnancy: a systematic review. Br J Haematol. 2006;132:171–96.

    Article  CAS  PubMed  Google Scholar 

  14. Pabinger I, Grafenhofer H, Kaider A, Ilic A, Eichinger S, Quehenberger P, Husslein P, Mannhalter C, Lechner K. Preeclampsia and fetal loss in women with a history of venous thromboembolism. Arterioscler Thromb Vasc Biol. 2001;21:874–9.

    Article  CAS  PubMed  Google Scholar 

  15. Bose P, Black S, Kadyrov M, Weissenborn U, Neulen J, Regan L, Huppertz B. Heparin and aspirin attenuate placental apoptosis in vitro: implications for early pregnancy failure. Am J Obstet Gynecol. 2005;192:​23–30.

    Article  CAS  PubMed  Google Scholar 

  16. Sebire NJ, Regan L, Rai R. Biology and pathology of the placenta in relation to antiphospholipid antibody-associated pregnancy failure. Lupus. 2002;11:641–3.

    Article  CAS  PubMed  Google Scholar 

  17. Isermann B, Sood R, Pawlinski R, Zogg M, Kalloway S, Degen JL, Mackman N, Weiler H. The thrombomodulin-protein C system is essential for the maintenance of pregnancy. Nat Med. 2003;9:331–7.

    Article  CAS  PubMed  Google Scholar 

  18. Greer IA, Nelson-Piercy C. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood. 2005;106:​401–7.

    Article  CAS  PubMed  Google Scholar 

  19. Royal College of Obstetricians & Gynaecologists. Greentop guideline no. 37. Thrombosis and embolism during pregnancy and the puerperium, reducing the risk. London; 2009. https://www.rcog.org.uk/guidelines.

  20. Howley HE, Walker M, Rodger MA. A systematic review of the association between factor V Leiden or prothrombin gene variant and intrauterine growth restriction. Am J Obstet Gynecol. 2005;192:694–708. 2002;99:614–9.

    Article  CAS  PubMed  Google Scholar 

  21. Kovalevsky G, Gracia CR, Berlin JA, Sammel MD, Barnhart KT. Evaluation of the association between hereditary thrombophilias and recurrent pregnancy loss: a meta-analysis. Arch Intern Med. 2004;164:​558–63.

    Article  PubMed  Google Scholar 

  22. Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet. 2003;361:901–8.

    Article  PubMed  Google Scholar 

  23. Rai R, Shlebak A, Cohen H, Backos M, Holmes Z, Marriott K, Regan L. Factor V Leiden and acquired activated protein C resistance among 1000 women with recurrent miscarriage. Hum Reprod. 2001;16:​961–5.

    Article  CAS  PubMed  Google Scholar 

  24. Pabinger I, Nemes L, Rintelen C, Koder S, Lechler E, Loreth RM, Kyrle PA, Scharrer I, Sas G, Lechner K, Mannhalter C, Ehrenforth S. Pregnancy-associated risk for venous thromboembolism and pregnancy outcome in women homozygous for factor V Leiden. Hematol J. 2000;1:37–41.

    Article  CAS  PubMed  Google Scholar 

  25. Vossen CY, Preston FE, Conard J, Fontcuberta J, Makris M, van der Meer FJ, Pabinger I, Palareti G, Scharrer I, Souto JC, Svensson P, Walker ID, Rosendaal FR. Hereditary thrombophilia and fetal loss: a prospective follow-up study. J Thromb Haemost. ​2004;​2:592–6.

    Article  CAS  PubMed  Google Scholar 

  26. Nelen WL, Blom HJ, Steegers EA, den Heijer M, Eskes TK. Hyperhomocysteinemia and recurrent early pregnancy loss: a meta-analysis. Fertil Steril. 2000;74:1196–9.

    Article  CAS  PubMed  Google Scholar 

  27. Unfried G, Griesmacher A, Weismuller W, Nagele F, Huber JC, Tempfer CB. The C677T polymorphism of the methylenetetrahydrofolate reductase gene and idiopathic recurrent miscarriage. Obstet Gynecol. 2002;99:614–9.

    Article  CAS  PubMed  Google Scholar 

  28. Foka ZJ, Lambropoulos AF, Saravelos H, Karas GB, Karavida A, Agorastos T, Zournatzi V, Makris PE, Bontis J, Kotsis A. Factor V Leiden and prothrombin G20210A mutations, but not methylenetetrahydrofolate reductase C677T, are associated with recurrent miscarriages. Hum Reprod. 2000;15:458–62.

    Article  CAS  PubMed  Google Scholar 

  29. Holmes ZR, Regan L, Chilcott I, Cohen H. The C677T MTHFR gene mutation is not predictive of risk for recurrent fetal loss. Br J Haematol. 1999;​105:98–101.

    Article  CAS  PubMed  Google Scholar 

  30. Makino A, Nakanishi T, Sugiura-Ogasawara M, Ozaki Y, Suzumori N, Suzumori K. No association of C677T methylenetetrahydrofolate reductase and an endothelial nitric oxide synthase polymorphism with recurrent pregnancy loss. Am J Reprod Immunol. 2004;52:60–6.

    Article  PubMed  Google Scholar 

  31. Van der Molen EF, Arends GE, Nelen WL, Van der Put NJ, Heil SG, Eskes TK, Blom HJ. A common mutation in the 5,10-methylenetetrahydrofolate reductase gene as a new risk factor for placental vasculopathy. Am J Obstet Gynecol. 2000;182:1258–63.

    Article  PubMed  Google Scholar 

  32. Lachmeijer AM, Arngrimsson R, Bastiaans EJ, Pals G, ten Kate LP, de Vries JI, Kostense PJ, Aarnoudse JG, Dekker GA. Mutations in the gene for methylenetetrahydrofolate reductase, homocysteine levels, and vitamin status in women with a history of preeclampsia. Am J Obstet Gynecol. 2001;184:394–402.

    Article  CAS  PubMed  Google Scholar 

  33. Murakami S, Matsubara N, Saitoh M, Miyakaw S, Shoji M, Kubo T. The relation between plasma homocysteine concentration and methylenetetrahydrofolate reductase gene polymorphism in pregnant women. J Obstet Gynaecol Res. 2001;27:349–52.

    Article  CAS  PubMed  Google Scholar 

  34. Kosmas IP, Tatsioni A, Ioannidis JP. Association of C677T polymorphism in the methylenetetrahydrofolate reductase gene with hypertension in pregnancy and pre-eclampsia: a meta-analysis. J Hypertens. 2004;22:1655–62.

    Article  CAS  PubMed  Google Scholar 

  35. Middeldorp S. Thrombophilia and pregnancy complications: cause or association? J Thromb Haemost. 2007;5 Suppl 1:276–82.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Trevor Baglin MA, MB ChB, PhD, FRCP, FRCPath .

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Baglin, T. (2015). Systemic Thromboembolism in Pregnancy: Heritable and Acquired Thrombophilias. In: Cohen, H., O'Brien, P. (eds) Disorders of Thrombosis and Hemostasis in Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-319-15120-5_3

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  • DOI: https://doi.org/10.1007/978-3-319-15120-5_3

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-15119-9

  • Online ISBN: 978-3-319-15120-5

  • eBook Packages: MedicineMedicine (R0)

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