Gestational Thrombophilia
Main Approaches to Diagnosis and Treatment
DOI:
https://doi.org/10.31686/ijier.vol10.iss1.3606Keywords:
Thrombophilia, Pregnancy, Venous Thromboembolism, DiagnosisAbstract
The woman's body undergoes several physiological changes during the gestational period. Risk factors and comorbidities can cause pathophysiological changes in this period, especially in the maternal vascular system, triggering thrombophilia. This clotting disorder increases the thrombus formation risk, especially in the uteroplacental circulation. The study aimed to conduct a thorough review of the main approaches to diagnosis and treatment in reducing patient morbidity and mortality. This is an integrative review with qualitative data searched in Pubmed, BVS and Cochrane Library. A total of 624 studies were found, 591 were excluded outside the inclusion criteria, and 33 were selected. According to the careful search, thrombophilias can be hereditary or acquired, the former when there is a predisposition to venous occlusion and the latter from other clinical conditions. Pregnancy is a pro-thrombotic event and increases the chances of thrombus occurrence, triggering a series of pregnancy complications, such as intrauterine death, early or late miscarriage, and premature birth. However, if diagnosed early, there is a favorable prognosis for the woman and the fetus. To reduce these impacts of gestational thrombophilia, it is imperative to train primary health care and private clinics professionals to promote and treat health and basic diagnostic tests on pregnant women. Thus, performing early intervention avoiding the development of maternal-fetal complications.
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References
De Stefano V, Rossi E, Paciaroni K, Leone G. Screening for inherited thrombophilia: indications and therapeutic implications. Haematologica, 2002;87(10):1095-1108. Available in: https://pubmed.ncbi.nlm.nih.gov/12368166/
Neves LB, Macedo DM, Lopes AC. Homocisteína. J Bras Patol Med Lab, 2004;40(5):311-320. https://doi.org/10.1590/S1676-24442004000500006 DOI: https://doi.org/10.1590/S1676-24442004000500006
D'Amico E, Daniel MM, Silveira PAA, Buccheri V. Manual de hematologia - Propedêutica e clínica. Rio de Janeiro: Medsi, 2003.
James AH, Jamison MG, Brancazio LR, Myers ER. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol, 2006;194(5):1311-1315. https://doi.org/10.1016/j.ajog.2005.11.008 DOI: https://doi.org/10.1016/j.ajog.2005.11.008
Meng K, Hu X, Peng X, Zhang Z. Incidence of venous thromboembolism during pregnancy and the puerperium: a systematic review and meta-analysis. J Matern Fetal Neonatal Med, 2015;28(3):245-253. https://doi.org/10.3109/14767058.2014.913130 DOI: https://doi.org/10.3109/14767058.2014.913130
Kourlaba G, Relakis J, Kontodimas S, Holm MV, Maniadakis N. A systematic review and meta-analysis of the epidemiology and burden of venous thromboembolism among pregnant women. Int J Gynaecol Obstet, 2016;132:4-10. https://doi.org/10.1016/j.ijgo.2015.06.054 DOI: https://doi.org/10.1016/j.ijgo.2015.06.054
Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015; 12(8):464-74. DOI: https://doi.org/10.1038/nrcardio.2015.83
Ferreira CM, Figueiró-Filho EAF, Oliveira VM, Pereira EFV. Thromboprophylaxis and maternal-fetal outcomes of women with serum markers for hereditary thrombophilia and previous obstetric complications. Rev Bras Saude Mater Infant, 2017;17(4):699-704. https://doi.org/10.1590/1806-93042017000400005 DOI: https://doi.org/10.1590/1806-93042017000400005
Mason C. Venous thromboembolism: a chronic illness. J Cardiovasc Nurs, 2009;24(6Suppl):S4-7. https://doi.org/10.1097/JCN.0b013e3181b85cbb. DOI: https://doi.org/10.1097/JCN.0b013e3181b85cbb
Simões CF, Barros AR, Moreschi Junior D. Conhecimento de gestantes a respeito de fatores de risco e prevenção de complicações vasculares na gestação. Iniciação Científica Cesumar, 2016;18:55-62. https://doi.org/10.17765/1518-1243.2016v18n1p55-62 DOI: https://doi.org/10.17765/1518-1243.2016v18n1p55-62
Heleno SSA. Fatores genéticos e cromossomais na perda gestacional: Artigo de revisão bibliográfica, ICBAS, 2014. Available in: https://repositorio-aberto.up.pt/bitstream/10216/76537/2/32669.pdf
Malagon N, Larsen E. Heredity and self-organization: partners in the generation and evolution of phenotypes. Int Rev Cell Mol Biol, 2015;315:153-181. https://doi.org/10.1016/bs.ircmb.2014.12.003 DOI: https://doi.org/10.1016/bs.ircmb.2014.12.003
Lijfering WM, Brouwer JL, Veeger NJ, et al. Selective testing for thrombophilia in patients with first venous thrombosis: results from a retrospective family cohort study on absolute thrombotic risk for currently known thrombophilic defects in 2479 relatives. Blood, 2009;113(21):5314-5322. https://doi.org/10.1182/blood-2008-10-184879 DOI: https://doi.org/10.1182/blood-2008-10-184879
Marques MA, Silveira PRM, Ristow AV, et al. Pesquisa de marcadores de trombofilia em eventos trombóticos arteriais e venosos: registro de 6 anos de investigação. J Vasc Bras, 2009;8(3):225-231. https://doi.org/10.1590/S1677-54492009000300007 DOI: https://doi.org/10.1590/S1677-54492009000300007
Martínez MC, Martínez AV, Reyes EA, Hernández AS, Jaimez MDF. Manejo obstétrico de la deficiencia hereditaria de antitrombina durante el embarazo y puerperio. Dos casos clínicos. Revista Brasileira de Saúde Materno Infantil, 2015;15(4):441-446. https://doi.org/10.1590/S1519-38292015000400008. DOI: https://doi.org/10.1590/S1519-38292015000400008
Practice Bulletin nº. 138. Inherited thrombophilias in pregnancy. Obstetrics & Gynecology, 2013;122(3):706-716. https://doi.org/10.1097/01.AOG.0000433981.36184.4e DOI: https://doi.org/10.1097/01.AOG.0000433981.36184.4e
Kalil JA, Jovino MAC, Lima MA, Kalil R, Magliari MER, Di Santo MK. Investigação da trombose venosa na gravidez. J Vasc Bras, 2008;7:28-37. https://doi.org/10.1590/S1677-54492008000100006. DOI: https://doi.org/10.1590/S1677-54492008000100006
Brazão ML, Silva AS, Gaspar J, Barros C, Pereira H, Araújo JN. Trombofilias e perdas embriofetais. Medicina Interna, revista da sociedade portuguesa de medicina interna. Rev Soc Port Med Int, 2010;17(4):213-221.
Figueiró-Filho EA, Oliveira VM, Coelho LR, Breda Serum markers of inherited thrombophilia and antiphospholipid antibodies in pregnant women with previous history of severe pre-eclampsia. Rev Bras Ginecol Obstet, 2012;34:40-46. https://doi.org/10.1590/s0100-72032012000100008 DOI: https://doi.org/10.1590/S0100-72032012000100008
Roberts JM, Taylor RN, Musci TJ, Rodgers GM, Hubel CA, McLaughlin MK. Preeclampsia: an endothelial cell disorder. Am J Obstet Gynecol; 1989;161(5):1200-1204. https://doi.org/10.1016/0002-9378(89)90665-0 DOI: https://doi.org/10.1016/0002-9378(89)90665-0
Salafia CM, Pezzullo JC, López-Zeno JA, Simmens S, Minior VK, Vintzileos AM. Placental pathologic features of preterm preeclampsia. Am J Obstet Gynecol, 1995;173(4):1097-1105. https://doi.org/10.1016/0002-9378(95)91333-5 DOI: https://doi.org/10.1016/0002-9378(95)91333-5
Shanklin DR, Sibai BM. Ultrastructural aspects of preeclampsia. I. Placental bed and uterine boundary vessels. Am J Obstet Gynecol, 1989;161(3):735-741. https://doi.org/10.1016/0002-9378(89)90392-x DOI: https://doi.org/10.1016/0002-9378(89)90392-X
Khong TY, Pearce JM, Robertson WB. Acute atherosis in preeclampsia: maternal determinants and fetal outcome in the presence of the lesion. Am J Obstet Gynecol, 1987;157(2):360-363. https://doi.org/10.1016/s0002-9378(87)80172-2 DOI: https://doi.org/10.1016/S0002-9378(87)80172-2
Salafia CM, Minior VK, Pezzullo JC, Popek EJ, Rosenkrantz TS, Vintzileos AM. Intrauterine growth restriction in infants of less than thirty-two weeks' gestation: associated placental pathologic features. Am J Obstet Gynecol, 1995;173(4):1049-1057. https://doi.org/10.1016/0002-9378(95)91325-4 DOI: https://doi.org/10.1016/0002-9378(95)91325-4
Green JR. Placenta prévia e descolamento da placenta. In: Creasy RK, Resnik R, editor. Medicina Materno-fetal: princípios e prática. Filadélfia: WB Saunders; 1994.
Infante-Rivard C, David M, Gauthier R, Georges-Etienne Rivard G-E. Lupus Anticoagulants, Anticardiolipin Antibodies, and Fetal Loss: A Case–Control Study. New England Journal of Medicine, 1991;325:1063-1066. https://doi.org/10.1056/NEJM199110103251503 DOI: https://doi.org/10.1056/NEJM199110103251503
Many A, Schreiber L, Rosner S, Lessing JB, Eldor A, Kupferminc MJ. Pathologic features of the placenta in women with severe pregnancy complications and thrombophilia. Obstet Gynecol, 2001;98:1041-1044. https://doi.org/10.1016/s0029-7844(01)01621-0 DOI: https://doi.org/10.1097/00006250-200112000-00010
Mousa HA, Alfirevic Z. Do placental lesions reflect thrombophilia state in women with adverse pregnancy outcome? Hum Reprod, 2000;15(8):1830-1833. https://doi.org/10.1093/humrep/15.8.1830 DOI: https://doi.org/10.1093/humrep/15.8.1830
Sikkema JM, Franx A, Bruinse HW, van der Wijk NG, de Valk HW, Nikkels PG. Placental pathology in early onset pre-eclampsia and intra-uterine growth restriction in women with and without thrombophilia. Placenta, 2002;23(4):337-342. https://doi.org/10.1053/plac.2001.0785 DOI: https://doi.org/10.1053/plac.2001.0785
Arias F, Romero R, Joist H, Kraus FT. Thrombophilia: a mechanism of disease in women with adverse pregnancy outcome and thrombotic lesions in the placenta. J Matern Fetal Med. 1998;7(6):277-286. https://doi.org/10.1002/(SICI)1520-6661(199811/12)7:6<277::AID-MFM5>3.0.CO;2-3 DOI: https://doi.org/10.1002/(SICI)1520-6661(199811/12)7:6<277::AID-MFM5>3.0.CO;2-3
Işık H, Alptekin H, Selimoglu R, Cengiz T, Küçükapan HU, Alptekin N.. Anticoagulant Therapy in Primary and Secondary Recurrent Pregnancy Losses with Hereditary Thrombophilia and Perinatal Outcomes. J Clin Exp Invest, 2016;7:29-34. https://doi.org/10.5799/jcei.328667 DOI: https://doi.org/10.5799/jcei.328667
Giancotti A, La Torre R, Spagnuolo A, et al. Efficacy of three different antithrombotic regimens on pregnancy outcome in pregnant women affected by recurrent pregnancy loss. J Matern Fetal Neonatal Med, 2012;25(7):1191-1194. https://doi.org/10.3109/14767058.2011.600366 DOI: https://doi.org/10.3109/14767058.2011.600366
Pimenta REF, Yoshida WB, Rollo HA, et al. Heparin induced thrombocytopenia in a patient with acute arterial occlusion. J Vasc Bras, 2016;15(2):138-141. http://dx.doi.org/10.1590/1677-5449.004215 DOI: https://doi.org/10.1590/1677-5449.004215
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Copyright (c) 2022 Ana Júlia Salim Casseb, Ana Letícia Salim Casseb, Ana Carolina Souza, Alice Magalhães, Alice Berto Canova, Andressa Borher Mello Pinheiro, Ana Clara Izidoro Barreto Miranda, Ana Paula Boaro, Beatriz Maine Berg, Camila Borges Bittencourt, Daiane Batista Mariano Silva, Laura de Oliveira Roveri, Lívia Sotero, Rogério Rodrigo Ramos
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Accepted 2021-12-31
Published 2022-01-01
