The significance of personalized monitoring of the hemostatic potential in a patient with combined thrombophilia concurrent with thrombocytopathy in enhancing the efficiency of in vitro fertilization

Background. The hemostatic and fibrinolytic systems play a key role in the systemic circulatory adaptation of the woman’s body to pregnancy and childbirth. In the presence of acquired or genetic hemostatic abnormalities (thrombophilia, thrombocytopathy, and coagulopathy), the physiological activation of coagulation processes and systemic inflammation during pregnancy can lead to decompensation in the equilibrium of the hemostatic potential (HP) and thereby provoke obstetric complications. Case report. The paper demonstrates a clinical observation of a female patient with concomitant hemostasiological disorders (thrombocytopathy, a carrier of heterozygous thrombophilia polymorphisms: ITGB3, ITGA2, PAI-1, and MTHFR). She has a history of repeated ineffective ART program attempts. Spontaneous abortion occurred during the early stages of hemorrhagic syndrome when low-molecular-weight heparin was used. An approach to managing this patient was proposed. The principle was the personalized monitoring of the hemostatic system by low-frequency thromboelastography. Owing to the latter, it was possible to have a real-time comprehensive and informative assessment of the parameters of hemocoagulation and fibrinolysis in whole blood. The detected HP disorders was corrected with the targeted therapy: Etamsilat (Lugansk Chemopharmaceutical Plant, Ukraine) was used to correct hypocoagulation at the f irst stage of fibrinogenesis; Tranexam (STADA, Russia) to suppress enhanced fibrinolytic activity; Vessel Due F (sulodexide) (Alfasigma S.p.A., Italy) to correct a hypercoagulable state, which should not have been routinely done in this patient, as thought by the authors. Monitoring the efficiency of the 2P+2D therapy could prolong pregnancy to full term, resulting in the birth of a healthy baby. Conclusion. Thus, the personalized approach to managing the patient with concomitant hemostasiological disorders and IVF contribute to the increased take-home-baby rate.

hemostasis and fibrinolysis, pregnancy, thromboelastography, thrombophilia, thrombocytopathy, Vessel Due F (sulodexide)