Coagulation challenges in pregnancy: from thrombophilia involvement and management to the utility of thrombin generation monitoring

Abstract

Despite numerous studies, there is no general agreement on an ideal biomarker for estimating thrombotic risk in pregnant women. However, it is accepted that the analysis of thrombin generation assesses the coagulation state more accurately compared to the classical tests used to investigate it. Increasing evidence has found that thrombin generation is correlated with overall plasma hypercoagulability, which is involved in the occurrence of major obstetrical syndromes, including preeclampsia, intrauterine growth restriction or recurrent abortions. It is difficult to investigate the thrombophilic mutations which, once discovered, are not able to quantify the thrombotic risk. The standardization of thrombin generation assay could allow a quantification of the individual thrombotic risk, which has a high variability, and would facilitate multicenter studies to establish the utility of thrombin generation monitoring for the prophylactic anticoagulant treatment in order to reduce pregnancy-related complications.