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Personalized Control of Anticoagulant and Antiplatelet Therapy for Pregnant Women with a Complicated Obstetric Anamnesis Is Pathogenetically Justified for the Purpose of Prevention of Placenta-associated Complications

1Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russian Federation, 2Medical Center “Aibolit”, Kazan, Russian Federation, 3Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation, 4City Clinical Hospital 16, Kazan, Russian Federation, 5Kazan State Medical University, Kazan, Russian Federation

Abstract Number: PB2546

Meeting: ISTH 2020 Congress

Theme: Women Health » Pregnancy and Pregnancy Complications

Background: Currently low-weight-molecular heparins (LWMH) are prescribed to pregnant women to prevent venous thromboembolic complications. There’re no recommendations for personalized selection of LWMH and acetylsalicylic acid (ASA) for women with recurrent pregnancy losses (RPL) to improve the outcome of pregnancy.

Aims: To prove the effectiveness of selection of LWMH and ASA for women with RPL to improve the outcome of pregnancy.

Methods: 120 women with RPL were included in the research. LWMH and ASA were administered individually when pathological hypercoagulation was detected based on D-dimer, XIIa-dependent fibrinolysis and thrombodynamics tests (global test) at the pregravidar preparation stage (group 1), or from the moment of pregnancy (group 2), or at any stage of pregnancy (group 3). During pregnancy the control of these tests was carried out at the end of LWMH effect every 4 weeks, the doses were corrected in case of deviation from the reference values.

Results: Group 3 patients didn´t receive NMG and showed more pronounced chronometric hypercoagulation at the inclusion stage according to the thrombodynamics test (increased speed parameters) and the highest percentage of fixation of spontaneous clot formation (33%).). The negative correlation (-0.71) between the time of XIIa-dependent fibrinolysis and the size of the clot was found in group 3. This shows the importance of detecting of decrease in the activity of fibrinolysis as a marker of pathological hypercoagulation. The dose of enoxaparin was assigned from 0.2 ml to 1.0 ml per day and didn’t depend on weight. The dose of ASA is from 50 mg to 150 mg per day. Successful carrying a child: 1st group – 91%, 2nd group – 87%, 3rd group – 76%.

Conclusions: These data indicate the pathogenetic role of disorder of fibrinolysis system in the formation of pathological hypercoagulation of women with RPL. Individual laboratory control of anticoagulation during pregnancy allows to improve pregnancy outcome.

To cite this abstract in AMA style:

Safiullina S, Vuimo T, Biktimirova D, Ilizarova N. Personalized Control of Anticoagulant and Antiplatelet Therapy for Pregnant Women with a Complicated Obstetric Anamnesis Is Pathogenetically Justified for the Purpose of Prevention of Placenta-associated Complications [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/personalized-control-of-anticoagulant-and-antiplatelet-therapy-for-pregnant-women-with-a-complicated-obstetric-anamnesis-is-pathogenetically-justified-for-the-purpose-of-prevention-of-placenta-associa/. Accessed October 1, 2023.

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