The significance of personalized monitoring of the hemostatic potential in a patient with combined thrombophilia concurrent with thrombocytopathy in enhancing the efficiency of in vitro fertilization
Background. The hemostatic and fibrinolytic systems play a key role in the systemic circulatory adaptation of the woman’s body to pregnancy and childbirth. In the presence of acquired or genetic hemostatic abnormalities (thrombophilia, thrombocytopathy, and coagulopathy), the physiological activation of coagulation processes and systemic inflammation during pregnancy can lead to decompensation in the equilibrium of the hemostatic potential (HP) and thereby provoke obstetric complications.Tyutrin I.I., Klimenkova V.F., Slizevich D.S., Shitikova O.G., Borzov E.A.
Case report. The paper demonstrates a clinical observation of a female patient with concomitant hemostasiological disorders (thrombocytopathy, a carrier of heterozygous thrombophilia polymorphisms: ITGB3, ITGA2, PAI-1, and MTHFR). She has a history of repeated ineffective ART program attempts. Spontaneous abortion occurred during the early stages of hemorrhagic syndrome when low-molecular-weight heparin was used. An approach to managing this patient was proposed. The principle was the personalized monitoring of the hemostatic system by low-frequency thromboelastography. Owing to the latter, it was possible to have a real-time comprehensive and informative assessment of the parameters of hemocoagulation and fibrinolysis in whole blood. The detected HP disorders was corrected with the targeted therapy: Etamsilat (Lugansk Chemopharmaceutical Plant, Ukraine) was used to correct hypocoagulation at the first stage of fibrinogenesis; Tranexam (STADA, Russia) to suppress enhanced fibrinolytic activity; Vessel Due F (sulodexide) (Alfasigma S.p.A., Italy) to correct a hypercoagulable state, which should not have been routinely done in this patient, as thought by the authors. Monitoring the efficiency of the 2P+2D therapy could prolong pregnancy to full term, resulting in the birth of a healthy baby.
Conclusion. Thus, the personalized approach to managing the patient with concomitant hemostasiological disorders and IVF contribute to the increased take-home-baby rate.
Keywords
hemostasis and fibrinolysis
pregnancy
thromboelastography
thrombophilia
thrombocytopathy
Vessel Due F (sulodexide)
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Received 16.11.2020
Accepted 24.11.2020
About the Authors
Ivan I. Tyutrin, Dr. Med. Sci., Professor, Professor of the Department of anesthesiology, resuscitation and intensive care, Siberian State Medical University,Ministry of Health of the Russian Federation. E-mail: ityutrinst@yandex.ru. ORCID: 0000-0001-9893-700X.
2 Moskovsky trakt str., Tomsk, 634050, Russia.
Valentina F. Klimenkova, Cand. Med. Sci., assistant of the Department of anesthesiology, resuscitation and intensive care, Siberian State Medical University,
Ministry of Health of the Russian Federation; Regional perinatal center named after I.D. Yevtushenko. Tel.: +7(3822)909-823, +7(3822)33-02-11.
E-mail: klimenkovavf@gmail.com. ORCID: 0000-0002-5506-2247. 2 Moskovsky trakt str., Tomsk, 634050, Russia; 96/1 I. Chernykh str., Tomsk, 634063, Russia.
Dmitry S. Slizevich postgraduate student, research school of chemical and biomedical technologies, National Research Tomsk Polytechnic University.
ORCID: 0000-0001-5053-1561 30 Lenin Ave., Tomsk, 634050, Russia.
Olga G. Shitikova, PhD, assistant of the Department of biochemistry and molecular biology with a course in clinical laboratory diagnostics, Siberian State Medical University, Ministry of Health of the Russian Federation. E-mail: olya.lya@mail.ru. ORCID: 0000-0002-4057-9964. Moskovsky trakt str., Tomsk, 634050, Russia.
Evgeny A. Borzov, post-graduate student of the Department of anesthesiology, resuscitation and intensive care, Siberian State Medical University, Ministry of Health of the Russian Federation; Regional perinatal center named after I.D. Yevtushenko. Tel.: +7(3822)909-823, +7(3822)33-02-11.
2 Moskovsky trakt str., Tomsk, 634050, Russia; 96/1 I. Chernykh str., Tomsk, 634063, Russia.
For citation: Tyutrin I.I., Klimenkova V.F., Slizevich D.S., Shitikova O.G., Borzov E.A. The significance of personalized monitoring of the hemostatic potential in a patient with combined thrombophilia concurrent with thrombocytopathy in enhancing the efficiency of in vitro fertilization.
Akusherstvo i Ginekologiya/ Obstetrics and Gynecology. 2020; 12: 249-254 (in Russian)
https://dx.doi.org/10.18565/aig.2020.12.249-254
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