Volumen: 22 # Number : Numero Extraordinario XIII Congreso del Grupo CAHT
Publication Date : Septiembre Year: 2018
SIMPOSIO CON OTRAS
ESPECIALIDADES
PARTE II - OBSTETRICIA Y
MEDICINA REPRODUCTIVA |
Is there a place for heparin and hereditary thrombophilia
in placental vascular insufficiency?
Authors: Sánchez-Luceros A1, Agazzoni M, Barrenechea M, Romero ML
Abstract: Early pre-eclampsia, abruptio placentae, intrauterine
growth restriction and stillbirth are different
manifestations of a common pathophysiologic
mechanism characterized by abnormal trophoblastic
invasion, being grouped under the term of placental
vascular insufficiency. Aspirin and low molecular
weight heparin are an effective treatment of the
obstetric antiphospholipid syndrome. However, the
benefit associated with hereditary thrombophilia and
gestational complications has not been established.
In recent years the use of heparin in women with
obstetric complications has increased, based on the
selection of previous pregnancies and not on the
thrombophilic defect. Few well designed trials, give
contradictory results and only marginal benefit. The
multiplicity of causal factors and heterogeneous
population of women enrolled in studies with
different heparins and different timings of onset
make it difficult to make recommendations. Despite
the effort made to carry out these trials, we have
made little progress in early identification of exposed
population and thus stratify the risk, to administer a
directed and evidence-based therapy. Until evidence
is available, hematologists need a guide for clinical
decision making. Research in the field of obstetric
complications with the development of accessible
potential biomarkers for early diagnosis, allow
categorize risk in different conditions to address the
disease process, rather than trying to prevent clinical
course. Meanwhile, the intervention for a laboratory
study and antithrombotic treatment should be guided
individually, considering each patient’s risk factors,
gestational complications and the thrombophilic
marker involved.
Key words: thrombophilia,
low molecular weight heparin,
placental vascular insufficiency.
Pages : 159-166
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