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How can changes in secondary haemostasis be useful for the management of pregnancy ?

1National Centre of Haemostasis and Thrombosis, Department of Haematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic, Martin, Zilina, Slovakia, 2National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital in Martin, Slovakia, Martin, Zilina, Slovakia, 3Comenius University, The Jessenius Faculty of Medicine in Martin, Martin, Zilina, Slovakia, 4Centre of Immunology in Martin, s.r.o., Martin, Slovak Republic, Martin, Zilina, Slovakia, 5Department of Internal Medicine I, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic, Martin, Zilina, Slovakia, 6Biomedical Center Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Slovakia, Martin, Zilina, Slovakia

Abstract Number: VPB1426

Meeting: ISTH 2022 Congress

Theme: Women’s Health » Pregnancy and Pregnancy Complications

Background: In the course of physiological pregnancy the haemostatic balance changes towards hypercoagulability. Low-molecular-weight heparin (LMWH) is recommended for secondary thromboprophylaxis in pregnant women with previous venous thromboembolism (VTE). However, there are only several studies focused on the effect of LMWH on haemostatic parameters during pregnancy of patients with prior VTE and thromboprophylaxis.

Aims: The authors present results of prospective and longitudinal evaluation of changes in haemostasis in high-risk pregnant women.

Methods: Blood samplings were performed during pregnancy (T1-T4) and once after the postpartum period (T5). Results of coagulation factor VIII (FVIII) activity, protein S (PS) function, ProC Global ratio and anti-Xa activity were assessed and compared with the control group. Written informed consent of included patients was obtained and the study was approved by the Ethics committee of the Jessenius Faculty of Medicine. Study complies with the Declaration of Helsinki. The authors do not have any conflict of interest.

Results: Despite secondary thromboprophylaxis, there was a significant increase in FVIII activity between T1 and T5 (p 0.0003), T2 and T4 (p 0.0144), T3 and T5 (p 0.0007) and between T4 and T5 (p < 0.0001). We observed decrease in PS function (T2-T5 vs. the controls, p value < 0.0001) and ProC Global ratio did not normalize after the postpartum period – p < 0.0001 between control group and T5 for both PS and ProC Global).

Conclusion(s): Regular testing of LMWH effectiveness in terms of routine monitoring of anti-Xa activity to tailor the dose of LMWH is not suggested. Our results show that haemostasis may not be restored even 6-8 weeks following delivery. Therefore, it is questionable when is it safe to withdraw secondary thromboprophylaxis in patients with previous VTE.

Acknowledgement: The authors thank the support of projects of the Agency for the Support of Research and Development APVV-16-0020 and Scientific Grant Agency (Vega) 1/0549/19.

To cite this abstract in AMA style:

Stanciakova L, Dobrotova M, Holly P, Zolkova J, Vadelova L, Skornova I, Ivankova J, Brunclikova M, Samos M, Bolek T, Grendar M, Kubisz P, Stasko J. How can changes in secondary haemostasis be useful for the management of pregnancy ? [abstract]. https://abstracts.isth.org/abstract/how-can-changes-in-secondary-haemostasis-be-useful-for-the-management-of-pregnancy/. Accessed September 27, 2023.

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