Prevention of complications of pregnancy in Factor V Leiden mutation carriers
Objective. To investigate the clinical and laboratory protective effects of heparin in Factor V Leiden (FVL) (1691) GA genotype carriers with a marked activated protein C (APC) resistance.Nikolaeva M.G., Momot A.P., Zainulina M.S., Momot K.A., Yasafova N.N.
Subjects and methods. A single-center randomized controlled study was conducted in 141 pregnant women [the FVL (1691) GA genotype] with APC resistance by an international normalized ratio (INR) of 0.49 or less. The study group patients (n=70) received heparin prophylaxis cycles at 7–8 weeks’ gestation; the comparison groups of pregnant women (n=71) did not use low-molecular-weight heparin (LMWH).
Results. During LMWH treatment, there were thrombin generation decreases determined by the thrombin generation test indicators: peak thrombin by 9-11% (p=0.008), endogenous thrombin potential (ETP) by 4–9% (p=0.013), and APC resistance by 9–14% (p < 0.05). The clinical protective effects of heparin were defined as a reduction in the absolute risk of developing preeclampsia by 29.5% (p=0.0003), fetal growth restriction by 23.8% (p=0.002), and preterm births by 12.6% (p=0.024).
Conclusion. Prophylaxis with heparin is pathogenetically justified and causes a significant decline in the number of pregnancy complications in FVL (1691) GA genotype carriers with a marked APC resistance (INR ≤0.49)
Keywords
Factor V Leiden (FVL) (1691) GA genotype
activated protein C (APC) resistance
thrombin generation
heparin prophylaxis
nadroparin calcium
preeclampsia
fetal growth restriction
References
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Received 08.06.2018
Accepted 22.06.2018
About the Authors
Nikolaeva, Maria G., MD, associate professor of the Department of Obstetrics and Gynecology, Altai State Medical University, Ministry of Health of Russia.656038, Russia, Barnaul, Lenin Pr. 40. Tel.: +79039962900. E-mail: nikolmg@yandex.ru. http://orcid.org/0000-0001-9459-5698
Momot, Andrey P., MD, Professor, Director of National Medical Research Center of Hematology, Ministry of Health of the Russian, Altai Branch.
656045, Russia, Barnaul, Lyapidevsky St. 1. Tel.: +73852689800. E-mail: xyzan@yandex.ru. http://orcid.org/0000-0002-8413-5484
Zainulina, Marina S., Professor, MD, Professor of the Department of Obstetrics, Gynecology and Reproduction, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia; Chief Physician, Altai Territorial Clinical Hospital.
656045, Russia, Barnaul, Lyapidevsky St. 1. Tel.: +78122735493. E-mail: zainulina@yandex.ru. http://orcid.org/0000-0002-2622-5000
Yasafova, Natalia N., hematologist, Altai Territorial Clinical Hospital. 656045, Russia, Barnaul, Lyapidevsky St. 1. Tel.: +79132163551.
E-mail: jasafova@mail.ru. https://orcid.org/0000-0001-5568-9122
Momot, Ksenia A., hematologist, Altai Territorial Clinical Hospital. 656045, Russia, Barnaul, Lyapidevsky St. 1. Tel.: +79136999666.
E-mail: mslove88@mail.ru. https://orcid.org/0000-0001-6325-0304
For citations: Nikolaeva M.G., Momot A.P., Zainulina M.S., Momot K.A., Yasafova N.N. Prevention of complications of pregnancy in Factor V Leiden mutation carriers. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (8): 160-6. (in Russian)
https://dx.doi.org/10.18565/aig.2018.8.160-166
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