Low molecular weight heparin for the prevention of gestational complications in women with different clinical types of thrombophilia

Lineva O.I., Davydkin I.L., Danilova O.E., Kurtov I.V., Shatunova  E.P., Tarasova A.V.

1) Samara State Medical University, Ministry of Health of the Russian Federation, Samara, Russia; 2) Medical University “Reaviz”, Samara, Russia
Objective. To define the role of genetic, acquired, and combined thrombophilias in the genesis of gestational complications and to evaluate the efficiency of prevention with nadroparin calcium.
Materials and methods. The protocols of a consultant’s appointment and the data of comprehensive examination were analyzed in 100 reproductive-aged women with thrombophilia and a family obstetric history.
Results. After the examination, the investigators formed follow-up groups of patients with the genetic hematogenic, acquired, and combined types of thrombophilia, who received preventive treatment with nadroparin calcium.
Conclusion. There is evidence for the priority and efficiency of nadroparin calcium use when the necessary interdisciplinary interaction is adhered.

Keywords

Keyword: thrombophilia
gestational complications
nadroparin calcium

References

  1. Galambosi P.J., Gissler M., Kaaja R.J., Ulander V.M. Incidence and risk factors of venous thromboembolism during postpartum period: a population-based cohord-study. Acta Obstet. Gynecol. Scand. 2017; 96(7): 852-61. https://doi.org/10.1111/aogs.13137.
  2. Rodger M., Le Gai G., Martinelli I., Perna A., Rey E., de Vries J.I., Gris J.C. Meta-analysis of low-molecular-weight heparin to prevent reccurent placenta – mediated pregnancy com plication. Blood. 2014; 123(6): 822-8. https://doi.org/10.1182/blood-2013-01-478958.
  3. Skeith L., Carrier M., Kaaja R., Martinelli I., Petroff D., Schleusner E. et al. A meta-analysis of low-molecular-weight heparin to prevent pregnancy loss in women with inherited thrombophilia. Blood. 2016; 127(13): 1650-5. https://doi.org/10.1182/blood-2015-12-626739.
  4. Alijotas-Reig J., Garrido-Gimenez C. Current concepts and new trends in the diagnosis and management of recurrent miscarriage. Obstet. Gynecol. Surv. 2013; 68(6): 445-66. https://doi.org/10.1097/OGX.0b013e31828aca19.
  5. Макацария А.Д., ред. Антифосфолипидный синдром – иммунная тромбофилия в акушерстве и гинекологии. М.: Триада-Х; 2007. 456 с. [Makatsariya A.D., ed. Antiphospholipid syndrome-immune thrombophilia in obstetrics and gynecology. Moscow: Triada-X; 2007. 456 p. (in Russian)].
  6. Бицадзе В.О., Макацария А.Д., Стрижаков А.Н., Червенак Ф.А., ред. Жизнеугрожающие состояния в акушерстве и перинатологии. М.: МИА; 2019. 672с. [Bitsadze V.O., Makatsaria A.D., Strizhakov A.N., Chervenak V.A., ed. Life threatening conditions in obstetrics and perinatology. Moscow: Medical Information Agency LLC, 2019: 672 p. (in Russian)].
  7. Clavijo M.M., Mahuad C.V., Aizpurua F.M., Ventura A., Casali C.E. Risk factors and role of low molecular weight heparin in obstetric complications among women with inherited thrombophilia – a cohort study. Hematol. Transfus. Cell. Ther. 2019; 41(4): 303-9. https://doi.org/10.1016/j.htct.2019.03.003.
  8. Фомина М.П., Ерошевская Д.В. Влияние терапии низкомолекулярными гепаринами на течение и исходы осложненной беременности. В кн.: Достижения фундаментальной, клинической медицины и фармации. Материалы 73-й научной сессии ВГМУ. Витебск, 29-30 января 2018 г. Витебск: ВГМУ; 2018; 1: 416-8. [Fomina M.P., Eroshevskaya D.V. Influence of low-molecular weight heparin therapy on the course and outcomes of complicated pregnancy. Achievements of fundamental, clinical medicine and pharmacy: materials of the 73rd scientific session VSMU, January 29-30, 2018. Vitebsk: VSMU, 2018; 1: 416-8(in Russian)].
  9. Kovac M., Mikovic Z., Mitic G., Djordjevic V., Mandic V., Rakicevic L., RadojkovicD. Does anticoagulant therapy improve pregnancy outcome equally, regardless of specific thrombophilia type? Clin. Appl. Thromb. Hemostas. 2014; 20(2): 184-9.
  10. Simeone R., Giacomello R., Bruno G., Parco S., Maximova M., Martinelli M. et al. Thrombogenesis in thrombophilic pregnancy: evaluation of low-molecular-weight heparin prophylaxis. Acta Haematol. 2017; 137: 201-6. https://doi.org/10.1159/000467385.
  11. Mutlu I., Mutlu M.F., Biri A., Bulut B., Erdem M., Erdem A. Effects of anticoagulant therapy on pregnancy outcomes in patients with thrombophilia and previous poor obstetric history. Blood Coagul. Fibrinolysis. 2015; 26(3): 267-73. https://doi.org/10.1097/MBC.0000000000000219.
  12. Ткаченко Л.В., Костенко Т.И., Складоновская Т.В., Хомич Е.А. Прегравидарная подготовка как основной метод профилактики неразвивающейся беременности. Гинекология. 2018; 20(4): 45-7. [Tkachenko L.V., Kostenko T.I., Skladovsskaya T.V., Khomich E.A. Pregravid preparation as the main method of preventing undeveloped pregnancy. Gynecology. 2018; 20(4): 45-7. (in Russian)]. https://doi.org/10.26442/2079-5696_2018.4.45-47.
  13. Рудакова Е.Б., Стрижова Т.В., Федорова Е.А., Замаховская Л.Ю. Возможности улучшения результативности программ экстракорпорального оплодотворения у «трудных» пациенток. Лечащий врач. 2019; 12: 14-9. [Rudakova E. B., Strizhova T. V., Fedorova E. A., Zamakhovskaya L. Yu. Opportunities to improve the effectiveness of in vitro fertilization programs in “difficult” patients. Attending physician, 2019; 12: 14-19. (in Russian)].
  14. Нормальная беременность. Клинические рекомендации. 2019. [Normal pregnancy. Clinical recommendations. 2019. (in Russian)]. https://docviewer.yandex.ru/view/0/?page=22&*=xeJ09oo7tOXby6jOBgPGisi2bap7InVybCI6InlhLWRpc2stcHVibGljOi8vVzZJSFh1VWpLdERmSlRIb1IxSjk2UHQvdGRIL1ovL3VXM1dCUFV1WCsrMXVCTkJBVC9mVW9OSjA4VXZaYVJTMnEvSjZicG1SeU9Kb25UM1ZvWG5EYWc9PSIsInRpdGxlIjoi0J3QvtGA0LzQsNC70YzQvdCw0Y8g0LHQtdGA0LXQvNC10L3QvdC%2B0YHRgtGMLmRvY3giLCJub2lmcmFtZSI6ZmFsc2UsInVpZCI6IjAiLCJ0cyI6MTU5NzkwMjQ2MzY0MiwieXUiOiI3ODY1ODcwNTMxNTk3OTAyMjkwIn0%3D
  15. Профилактика венозных тромбоэмболических осложнений в акушерстве и гинекологии. Протокол. Клинические рекомендации. Акушерство и гинекология. 2014; 10 (Приложение): 1-18. [Prevention of venous thromboembolic complications in obstetrics and gynecology. Protocol. Clinical recommendations. Obstetrics and gynecology (Attachment). 2014; 10: 1-18. (in Russian)].
  16. Савельева Г.М., Сухих Г.Т., Серов В.Н., Радзинский В.Е., ред. Акушерство. Национальное руководство. М.: ГЭОТАР-Медиа; 2015. 1080 с. [Saveleva G.M., Sukhykh G.T., Serov V.N., Radzinsky V.E., ed. Obstetrics: national guideline. M.: GEOTAR-Media, 2015: 1080 p. (in Russian)].
  17. Fareed J., Walenga J.M., Hoppensteadt D., Huan X., Nonn R. Biochemical and pharmacologic inequivalence of low molecular weight heparins. Ann. N. Y. Acad. Sci. 1989; 556: 333-53.
  18. Кумыкова З.Х. Применение Фраксипарина во время планирования и ведения беременности при привычном невынашивании. Акушерство и гинекология: новости, мнения, обучение. 2015; 4: 77-80. [Kumykova Z.Kh. Fraxiparine prescription during planning and management of pregnancy in case of habitual miscarriage. Obs. and Gynec. news, opinions, training. 2015; 4(10): 77-80 (in Russian)].
  19. Сердюк Г.В., Баркаган З.С. Применение низкомолекулярного гепарина надропарина (фраксипарина) при беременности. Трудный пациент. 2006; 4(2): 15-8. [Serdyuk G.V., Barkagan Z.S. Application of low-molecular weight heparin nadroparin (fraxiparin) during pregnancy. Difficult patient. 2006;2(4):15-8 (in Russian)].
  20. Пюрбеева Е.Н., Зайнуллина М.С., Зубжицкая Л.Б. Эффективность применения фраксипарина у беременных с врожденной тромбофилией и синдромом задержки развития внутриутробного плода. Журнал акушерства и женских болезней. 2008; 57(3): 12-7. [Pyurbeeva E.N., Zainullina M.S., Zubzhitskaya L.B. Effectiveness of fraxiparin in pregnant women with congenital thrombophilia and fetal development delay syndrome. Journal of obstetrics and women’s diseases. 2008; 3: 12-7. (in Russian)].
  21. Ruffatti A., Gervasi M.T., Favaro1 M., Ruffatti A.T., Hoxha A., Punzi L. Adjusted prophylactic doses of nadroparin plus low dose aspirin therapy in obstetric antiphospholipid syndrome. A prospective cohort management study. Clin. Exp. Rheumatol. 2011; 29(3): 551-4.
  22. The European pharmacopoeia 6.0., 2008: 2467-2470.

Received 09.07.2020

Accepted 05.08.2020

About the Authors

Olga I.Lineva, Honored Doctor of the Russian Federation, Doctor of Medicine, professor, professor of the Department of Obstetrics and Gynecology IPE of SSMU.
Tel.: +7(927)651-18-48. E-mail: oilineva@yandex.ru. ORCID: 0000-0003-2232-0980. 89 Chapaevskaya str., Samara, 443099, Russian Federation.
Igor L. Davidkin, Doctor of Medicine, Professor, Vice-rector for Research and Innovation work, the Head of the Depatment and Clinics of Hospital Therapy with the Course of Transfusiology, Director of Scientific Research Institute of Hematology of SSMU. Tel.: +7(927)014-55-44. E-mail: dagi2006@rambler.ru. eLibrary SPIN: 1830-7497;
ORCID: 0000- 0003-0645-7645; Web of Science: P-9806-2015; Scopus ID: 24337358600. 89 Chapaevskaya str., Samara, 443099, Russian Federation.
Olesya E. Danilova, MD, candidate of medical sciences, the Department of Hospital therapy with the course of polyclinical therapy and transfusiology.
Tel.: +7(987)987-09-83. E-mail: dani29051978@yandex.ru. eLibrary SPIN: 5043-7017;
ORCID: 0000-0002-3477-1140; Web of Science: Н-1228-2019; Scopus ID: 57189728896. 89 Chapaevskaya str., Samara, 443099, Russian Federation.
Igor V. Kurtov, MD, candidate of medical sciences, the Department of Hospital therapy with the course of polyclinical therapy and transfusiology.
Tel.: +7(903)309-26-06. E-mail: sam-med@mail.ru. ORCID: 0000- 0003-0420-5735. 89 Chapaevskaya str., Samara, 443099, Russian Federation.
Elena P. Shatunova, doctor of medical Sciences, Professor, Нead of the Department of obstetrics and gynecology with a course of endoscopic surgery and simulation training at the Medical University “Reaviz”. Tel.: +7(846)333-54-51; +7(927)692-52-99. Е-mail: e.shatunova@mail.ru. ORCID: 0000-0001-7381-2243.
443001, Samara, Chapaevskaya str., 227.
Anastasia V. Tarasova, post-graduate student of the Department of obstetrics and gynecology with a course of endoscopic surgery and simulation training at the Medical University “Reaviz”, obstetrician-gynecologist at the Samara N.I. Pirogov city hospital No.1.
Tel.: +7(927)702-96-69. Е-mail: knopochka663922@mail.ru. ORCID: 0000-0002-2849-0844. 443001, Samara, Chapaevskaya str., 227.

For citation: Lineva O.I., Davydkin I.L., Danilova O.E., Kurtov I.V., Shatunova E.P., Tarasova A.V. Low molecular weight heparin for the prevention of gestational complications in women with different clinical types of thrombophilia.
Akusherstvo i Ginekologiya/ Obstetrics and Gynecology. 2020; 8: 170-176 (in Russian).
https://dx.doi.org/10.18565/aig.2020.8.170-176

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.