Sociedad Argentina de Hematología

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Revista Argentina de Hematología

Abstract

Volumen:    22    # Number : Numero Extraordinario XIII Congreso del Grupo CAHT

Publication Date :    Septiembre    Year:    2018

   SIMPOSIO CON OTRAS ESPECIALIDADES PARTE II - OBSTETRICIA Y MEDICINA REPRODUCTIVA

Is there a place for heparin and hereditary thrombophilia in placental vascular insufficiency?

Authors: Sánchez-Luceros A1, Agazzoni M, Barrenechea M, Romero ML

Abstract: Early pre-eclampsia, abruptio placentae, intrauterine growth restriction and stillbirth are different manifestations of a common pathophysiologic mechanism characterized by abnormal trophoblastic invasion, being grouped under the term of placental vascular insufficiency. Aspirin and low molecular weight heparin are an effective treatment of the obstetric antiphospholipid syndrome. However, the benefit associated with hereditary thrombophilia and gestational complications has not been established. In recent years the use of heparin in women with obstetric complications has increased, based on the selection of previous pregnancies and not on the thrombophilic defect. Few well designed trials, give contradictory results and only marginal benefit. The multiplicity of causal factors and heterogeneous population of women enrolled in studies with different heparins and different timings of onset make it difficult to make recommendations. Despite the effort made to carry out these trials, we have made little progress in early identification of exposed population and thus stratify the risk, to administer a directed and evidence-based therapy. Until evidence is available, hematologists need a guide for clinical decision making. Research in the field of obstetric complications with the development of accessible potential biomarkers for early diagnosis, allow categorize risk in different conditions to address the disease process, rather than trying to prevent clinical course. Meanwhile, the intervention for a laboratory study and antithrombotic treatment should be guided individually, considering each patient’s risk factors, gestational complications and the thrombophilic marker involved.

Key words: thrombophilia, low molecular weight heparin, placental vascular insufficiency.

Pages : 159-166

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