Current possibilities of personalized thromboprophylaxis when implementing an assisted reproductive technology protocol and during pregnancy in women at high risk for venous thromboembolism
Background. Personalized anticoagulant prevention of venous thromboembolism (VTE) in women with a complicated obstetric history (COH) and thrombophilia can prolong pregnancy and improve its outcome. Therapy can be individually monitored by global tests evaluating the hemostatic system.Safiullina S.I., Vuimo T.A., Ilizarova N.A., Sabirova V.L., Sigitova O.N., Pyregov A.V.
Case report. The paper gives an example of managing a patient with COH and thrombophilia at high risk for VTE (congenital antithrombin III deficiency) in the assisted reproductive technology (ART) protocol and during pregnancy. The dose of anticoagulants was controlled and adjusted using the routine and global hemostasis tests until the pregnancy was successfully completed: delivery by caesarean section at 38 weeks’ gestation; a full-term baby weighing 3980 g; an Apgar score of 9.
Conclusion. Implementation of the ART protocol in women with thrombophilia at high risk for VTE should be accompanied by careful hemostasiological monitoring and individual choice of anticoagulant prevention. When severe underlying pathological hypercoagulation or evident uncontrollable hemostasis is identified by the time of embryo transfer, the latter should be postponed until hemostasis is stabilized.
Keywords
pregnancy
thrombosis prevention
low-molecular-weight heparins
thrombodynamics
Supplementary Materials
- Fig. 1. The algorithm for the control of thromboprophylaxis with heparins
- Fig. 2. Indicators Vst test TD, a dose of low-molecular heparin during the IVF protocol
- Fig. 3. The result of NATEM thromboelastometry at the peak of the action of low-molecular-weight heparin in patient K.A. at 36 weeks
- Table. Indicators of routine hemostasis and thrombodynamics test of patient K.A (during pregnancy)
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Received 01.03.2017
Accepted 28.04.2017
About the Authors
Svetlana I. Safiullina, Ph.D., Teaching Fellow, Kazan State Medical University Chair of General Medical Practice; Hematologist, Medical Center «Aybolit» LLC.420012, Russia, Kazan, Butlerova str. 49. Tel.: +79274199176. E-mail: svetlana.ild.safiullina@gmail.com. ORCID ID: orcid.org/0000-0003-4657-0140
Tatiana A. Vuimo, Cand. Biol. Med., Leading Research in Laboratory of Translational medicine, Higher School of Molecular and Experimental Medicine,
Dmitry Rogachev Federal Research Clinical Center of Pediatric Hematology, Oncology, and Immunology, Ministry of Health of Russia.
117997, Russia, Moscow, Samory Mashela str. 1. Tel.: +74952876570. E-mail tagaty@yandex.ru ORCID ID: orcid.org/0000-0003-3491-1884
Natalia A. Ilizarova, Ph.D., Dr. Scient. Med, Assistant Professor, Chair of Obstetrics and Gynecology № 2, Kazan State Medical University.
420012, Russia, Kazan, Butlerova str. 49. Tel.: +78435565497. E-mail: nilizarova@mail.ru. ORCID ID: orcid.org/0000-0001-9087-4294
Venera L. Sabirova, obstetrician-gynecologist – reproductologist, head of the department of IVF, OOO “Ava Kazan” Multidisciplinary Clinic.
420001, Russia, Kazan, Profsoyuznaya str. 19/15. Tel.: +78432020642. E-mail: venera.sabirova.83@mail.ru. ORCID ID: orcid.org/0000-0002-4251-7003
Olga N. Sigitova, professor, doctor of medical Sciences, head of the Department of General practice, Kazan State Medical University.
420012, Russia, Kazan, Butlerova str. 49. Tel.: +78432312139. E-mail: osigit@rambler.ru
Alexey V. Pyregov, Ph.D., Head of the Department of Anesthesiology and Reanimation, Research Center of Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia. 117997, Russia, Moscow , Ac. Oparina str. 4. Tel.: +74954383310. E-mail pyregov@mail.ru
For citations: Safiullina S.I., Vuimo T.A., Ilizarova N.A., Sabirova V.L.,Sigitova O.N., Pyregov A.V. Current possibilities of personalized thromboprophylaxis when implementing an assisted reproductive technology protocol and during pregnancy
in women at high risk for venous thromboembolism. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (4): 144-9. (in Russian)
https://dx.doi.org/10.18565/aig.2018.4.144-149
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