▸ There is no current support for screening for inherited thrombophilia in women experiencing recurrent unexplained fetal loss or other adverse pregnancy outcomes. Diagnosis and treatment regimens should occur only in the context of an institutional review board–approved research protocol.
▸ Patients with known inherited thrombophilia and a personal or family history of prior VTE should receive antepartum thromboprophylaxis followed by postpartum anticoagulation.
▸ Unless they have additional, significant risk factors, women with lower-risk thrombophilias (i.e., heterozygotes for FVL, PGM, protein C deficiency, or protein S deficiency) and no history of prior VTE or an affected first-degree relative do not require antepartum thromboprophylaxis.
▸ Women who have a personal history of VTE associated with a nonrecurrent risk factor should be screened.
Source: Dr. Lockwood
Thrombophilia and Adverse Outcomes
Adverse pregnancy outcomes are among the most perplexing pregnancy-related problems because we still have little precise knowledge about the etiology—and often, the mechanisms—associated with them. Over time, a number of causes have been identified and suggested, and some potential therapeutic agents have been proposed.
The relationship between thrombophilia and adverse outcomes has been a long-term association. A number of experiential reports and uncontrolled trials have endorsed this relationship. In fact, experimental therapeutic trials with heparin and other agents have attempted to improve outcomes and have reported incremental benefits when these agents have been used.
This has further galvanized the belief that thrombophilia may in fact be strongly etiologic in the pathophysiology of some adverse pregnancy outcomes. Thus, interventions based on a presumed mechanistic basis have been supported. However, newer data have seemed not to bear out this long-held association between thrombophilia and adverse outcomes, and the implied treatment.
It is in light of this controversy and the conflicting positions that we have decided to do a Master Class to thoroughly review the subject, to look at what data exist that can help unravel this relationship, and to examine whether screening patients for thrombophilia and treating it as a basis for improving pregnancy outcomes is warranted.
We have invited Dr. Charles J. Lockwood to address the topic. Dr. Lockwood is the Anita O'Keeffe Young Professor of Women's Health and chair of the department of obstetrics, gynecology, and reproductive sciences at Yale University, New Haven, Conn., and chief of obstetrics and gynecology at Yale–New Haven Hospital.
Dr. Lockwood has studied and thought a great deal about the association between inherited thrombophilia and adverse pregnancy outcomes, as well as the association between thrombophilia and maternal thrombosis. He urges us to step back and, in light of a “new landscape of research findings,” take a more careful approach to assessment and screening.