A PERSONALIZED APPROACH TO CORRECTION OF HEMOSTATIC DISORDERS AND THROMBOPROPHYLAXIS IN PREGNANT WOMEN WITH A COMPLICATED OBSTETRIC HISTORY


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Abstract

Objective. To provide a rationale for the need for an individual approach to anticoagulant therapy (with low-molecular-weight heparins (LMWHs) in combination and without acetylsalicylic acid (ASA) and its laboratory monitoring in pregnant women with a complicated obstetric history to improve a pregnancy outcome. Subjects and methods. This investigation enrolled 58 patients with a complicated obstetric history. The patients were divided into 4 subgroups: 1) patients with a history of infertility; 2) those having a history of early miscarriage before 12 weeks’ gestation; 3) those with a history of late miscarriage at 12 to 22 weeks’ gestation; 4) those with a history of preterm birth at 22 to 36 weeks. At their inclusion in the investigation, all the patients were examined involving their genetic passport (thrombophilia, cardiac risk assessment), extended coagulogram, and thrombodynamics assay. The hemostastic system was monitored every 2 weeks. Results. ITGA2, ITGB3, and PAI-1 polymorphisms were found to be of high significance for pregnancy losses at different stages. Analysis of hemostatic parameters revealed that the late miscarriage group had signif icantly higher Vst in the thrombodynamics assay and the highest rate (33.3%) of spontaneous thrombosis, indicating a hypercoagulable state. The summing up of the results showed that there was successful birth in 24 (41.3%) patients and no pregnancy loss. Conclusion. The decision regarding antithrombotic therapy with LMWHs with or without ASA in the identification of a prothrombotic state should be individualized on the basis of a patient’s medical history (a personal obstetric or family history of thrombosis) and be guided by global hemostatic tests.

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About the authors

Svetlana I. Safiullina

Email: sveta03@mail.ru
Ph.D., Teaching Fellow, Chair of General Medical Practice, Kazan State Medical University. Hematologist, Aibolit Medical Center. 420012, Russia, Kazan, Butlerova str. 49; 420102, Russia, Kazan, Serova str. 51/11

Tatiana A. Vuimo

Email: tagaty@yandex.ru
Cand. Biol. Scien., Leading Research in Laboratory of Translational medicine, Higher School of Molecular and Experimental Medicine, Dmitry Rogachev Federal Research-and-Clinical Center for Pediatric Hematology, Oncology, and Immunology, Ministry of Health of Russia. 117997, Russia, Moscow, Samory Mashela str. 1

Natalia A. Ilizarova

Email: nilizarova@mail.ru
MD, Assistant Professor, Chair of Obstetrics and Gynecology № 2, Kazan State Medical University. 420012, Russia, Kazan, Butlerova str. 49

Konstantin I. Grishuk

Email: grischuk.konstantin@ya.ru
MD, Department of Anaesthesiology, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia 117997, Russia, Moscow, Ac. Oparina str. 4

Aleksey V. Pyregov

Email: pyregov@mail.ru
Ph.D., Head of Department of Anaesthesiology, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia 117997, Russia, Moscow, Ac. Oparina str. 4

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