Clinical guidance for peripartum management of patients with hereditary thrombophilia

Abstract

Hereditary thrombophilia is a condition in which individuals are susceptible to the formation of thrombi due to a hereditary deficiency in anticoagulant factors, antithrombin (AT), protein C (PC), or protein S (PS). Many Japanese thrombophilia patients have PS deficiency, especially PS p.K196E (also called as PS Tokushima), which is exclusive to the Japanese population, and thrombosis sometimes occurs during pregnancy. At present, no management guidelines for pregnancy and delivery in thrombophilia patients have been developed. The Study Group for Hereditary Thrombophilia, one of the research groups of blood coagulation abnormalities in the Research Program on Rare and Intractable Diseases supported with the Research Grants of the Ministry of Health, Labour and Welfare Science, has therefore developed this clinical guidance to provide healthcare workers with necessary information on safe pregnancy, parturition and neonatal management, adopting a format of responses to seven clinical questions (CQ). At the end of each answer, the corresponding Recommendation Level (A, B, C) is indicated.

The clinical and genetic landscape of early‐onset thrombophilia in Japan

“…Maternal thrombophilia is associated with recurrent fetal loss and implantation failure 41 . Pregnant mothers with heritable thrombophilia need appropriate anticoagulation and/or replacement therapy during the pregnancy course 13,42 . The majority of neonatal thrombosis cases develop in the first 3 days of life, with or without thrombophilia 12 .…”

“…41 Pregnant mothers with heritable thrombophilia need appropriate anticoagulation and/or replacement therapy during the pregnancy course. 13,42 The majority of neonatal thrombosis cases develop in the first 3 days of life, with or without thrombophilia. 12 Prenatal genetic testing for thrombophilia may determine the need for the management of subsequent pregnancies.…”

“…Thrombotic events may develop in newborns and mothers before or after delivery 12 . Recently, clinical guidance for peripartum management of patients with inherited thrombophilia has been proposed 13 . Nevertheless, asymptomatic parents and their offspring face a hurdle in universal screening in terms of cost‐effectiveness.…”

Inflammation Indexes PLR, SII, AISI, MLR, NLPR and MCVL in Peripartum Treated Thrombophilia Patients Undergoing Cesarean Section at Term-STROBE Compliant

“…The administration of lowmolecular-weight heparin (LMWH) is adapted to each pregnant patient. The treatment stops when labor pain occurs or 6 hours before the planned cesarean section, and it restarts after delivery [16]. They report a protective effect of LMWH on miscarriage in patients with a history of unexpected recurrent pregnancy losses due to thrombophilia [17][18][19][20].…”

Inflammation Indexes PLR, SII, AISI, MLR, and MCVL in Peripartum Treated Thrombophilia Peripartum Patients Undergoing Cesarean Section at Term

“…The administration of low-molecular-weight heparin (LMWH) is adapted to each pregnant patient. The treatment stops when labor pain occurs or 6 hours before the planned cesarean section, and it restarts after delivery [9].…”