Sex Hormones, Contraceptives, and Thrombotic Risk: Where Are We Now?| November 25, 2024 Inherited thrombophilia and recurrent miscarriage: is there a role for anticoagulation during pregnancy? Evidence-Based Minireview Leslie Padrnos, Leslie Padrnos 1Division of Hematology-Oncology, Mayo Clinic, Phoenix, AZ Search for other works by this author on: This Site PubMed Google Scholar Radhika Gangaraju Radhika Gangaraju 2Division of Hematology-Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL Correspondence Radhika Gangaraju, Assistant Professor, Department of Medicine, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 500, Birmingham, AL 35233; e-mail: [email protected]. Search for other works by this author on: This Site PubMed Google Scholar Hematology Am Soc Hematol Educ Program (2024) 2024 (1): 672–677. https://doi.org/10.1182/hematology.2024000672 Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Request Permissions Cite Icon Cite Search Site Citation Leslie Padrnos, Radhika Gangaraju; Inherited thrombophilia and recurrent miscarriage: is there a role for anticoagulation during pregnancy?. Hematology Am Soc Hematol Educ Program 2024; 2024 (1): 672–677. doi: https://doi.org/10.1182/hematology.2024000672 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsHematology, ASH Education Program Search Subjects: Evidence-Based Minireview Learning ObjectivesReview the association between inherited thrombophilia and recurrent miscarriageDiscuss key evidence informing anticoagulation use and pregnancy outcomes in women with inherited thrombophilia and recurrent miscarriage A 32-year-old woman was referred to you at 15 weeks gestation regarding anticoagulation management. She has a history of 2 prior miscarriages at weeks 12 and 15, and she reports that she has a homozygous prothrombin gene mutation (PGM). She denies any personal or family history of venous thromboembolism. How would you approach anticoagulation in this patient? Recurrent pregnancy loss (RPL) affects 1%-5% of couples, placing a significant psychological and physical burden on women and families and increasing health care costs. The etiology for RPL remains unexplained in half of the cases despite extensive evaluation, and physicians and patients resort to treatment modalities that have uncertain benefit in an attempt to achieve... References 1.El Hachem H, Crepaux V, May-Panloup P, Descamps P, Legendre G, Bouet P-E. Recurrent pregnancy loss: current perspectives. Int J Womens Health. 2017;9:331-345.Google ScholarCrossrefSearch ADS PubMed 2.Robertson L, Wu O, Langhorne P, et al; Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) Study. Thrombophilia in pregnancy: a systematic review. Br J Haematol. 2006;132(2):171-196.Google ScholarCrossrefSearch ADS PubMed 3.Vossen CY, Preston FE, Conard J, et al. Hereditary thrombophilia and fetal loss: a prospective follow-up study. J Thromb Haemost. 2004;2(4):592-596.Google ScholarCrossrefSearch ADS PubMed 4.Rodger MA, Betancourt MT, Clark P, et al. The association of factor V leiden and prothrombin gene mutation and placenta-mediated pregnancy complications: a systematic review and meta-analysis of prospective cohort studies. PLoS Med. 2010;7(6):e1000292.Google ScholarCrossrefSearch ADS PubMed 5.Liu X, Chen Y, Ye C, et al. Hereditary thrombophilia and recurrent pregnancy loss: a systematic review and meta-analysis. Hum Reprod. 2021;36(5):1213-1229.Google ScholarCrossrefSearch ADS PubMed 6.American College of Obstetricians and Gynecologists' Committee on Practice Bulletins–Obstetrics. ACOG Practice Bulletin No. 197: inherited thrombophilias in pregnancy. Obstet Gynecol. 2018;132(1):e18-e34.CrossrefSearch ADS PubMed 7.Middeldorp S. Anticoagulation in pregnancy complications. Hematology Am Soc Hematol Educ Program. 2014;2014(1):393-399.Google ScholarCrossrefSearch ADS PubMed 8.Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos A-M, Vandvik P-O. VTE, thrombophilia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 suppl):e691S-e736S.Google ScholarPubMed 9.Bates SM, Rajasekhar A, Middeldorp S, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv. 2018;2(22):3317-3359.Google ScholarCrossrefSearch ADS PubMed 10.Grandone E, Tiscia GL, Mastroianno M, et al. Findings from a multicentre, observational study on reproductive outcomes in women with unexplained recurrent pregnancy loss: the OTTILIA registry. Hum Reprod. 2021;36(8):2083-2090.Google ScholarCrossrefSearch ADS PubMed 11.Rodger MA, Hague WM, Kingdom J, et al; TIPPS Investigators. Antepartum dalteparin versus no antepartum dalteparin for the prevention of pregnancy complications in pregnant women with thrombophilia (TIPPS): a multinational open-label randomised trial. Lancet. 2014;384(9955):1673-1683.Google ScholarCrossrefSearch ADS PubMed 12.de Jong PG, Kaandorp S, Di Nisio M, Goddijn M, Middeldorp S. Aspirin and/or heparin for women with unexplained recurrent miscarriage with or without inherited thrombophilia. Cochrane Database Syst Rev. 2014;2014(7):CD004734.Google ScholarPubMed 13.Chen Y, Wang T, Liu X, et al. Low molecular weight heparin and pregnancy outcomes in women with inherited thrombophilia: a systematic review and meta-analysis. J Obstet Gynaecol Res. 2022;48(8):2134-2150.Google ScholarCrossrefSearch ADS PubMed 14.Skeith L, Carrier M, Kaaja R, et al. A meta-analysis of low-molecular-weight heparin to prevent pregnancy loss in women with inherited thrombophilia. Blood. 2016;127(13):1650-1655.Google ScholarCrossrefSearch ADS PubMed 15.Leaf RK, Connors JM. The role of anticoagulants in the prevention of pregnancy complications. Clin Appl Thromb Hemost. 2017;23(2):116-123.Google ScholarCrossrefSearch ADS PubMed 16.Quenby S, Booth K, Hiller L, et al; ALIFE2 Block Writing Committee; ALIFE2 Investigators. Heparin for women with recurrent miscarriage and inherited thrombophilia (ALIFE2): an international open-label, randomised controlled trial. Lancet. 2023;402(10395):54-61.Google ScholarCrossrefSearch ADS PubMed 17.ACOG Committee Opinion No. 743: low-dose aspirin use during pregnancy. Obstet Gynecol. 2018;132(1):e44-e52.CrossrefSearch ADS PubMed Copyright © 2024 by The American Society of Hematology2024 Copyright © 2024 by The American Society of Hematology2024 You do not currently have access to this content.