Prevention, management and extent of adverse pregnancy outcomes in women with hereditary antithrombin deficiency

Nina Rogenhofer; Michael K Bohlmann; Petra Beuter-Winkler; Wolfgang Würfel; Andreas Rank; Christian J Thaler; Bettina Toth

doi:10.1007/s00277-013-1892-0

Prevention, management and extent of adverse pregnancy outcomes in women with hereditary antithrombin deficiency

Ann Hematol. 2014 Mar;93(3):385-92. doi: 10.1007/s00277-013-1892-0. Epub 2013 Sep 3.

Authors

Nina Rogenhofer¹, Michael K Bohlmann, Petra Beuter-Winkler, Wolfgang Würfel, Andreas Rank, Christian J Thaler, Bettina Toth

Affiliation

¹ Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Ludwig-Maximilians University-Großhadern, Marchioninistrasse 15, 81377, Munich, Germany, nina.rogenhofer@med.uni-muenchen.de.

PMID: 23999648
DOI: 10.1007/s00277-013-1892-0

Abstract

Antithrombin (AT) deficiency is a rare hereditary thrombophilia with a mean prevalence of 0.02 % in the general population, associated with a more than ten-fold increased risk of venous thromboembolism (VTE). Within this multicenter retrospective clinical analysis, female patients with inherited AT deficiency were evaluated concerning the type of inheritance and extent of AT deficiency, medical treatment during pregnancy and postpartally, VTE risk as well as maternal and neonatal outcome. Statistical analysis was performed with SPPS for Windows (19.0). A total of 18 pregnancies in 7 patients were evaluated, including 11 healthy newborns ≥37th gestational weeks (gw), one small for gestational age premature infant (25th gw), two late-pregnancy losses (21st and 28th gw) and four early miscarriages. Despite low molecular weight heparin (LMWH) administration, three VTE occurred during pregnancy and one postpartally. Several adverse pregnancy outcomes occurred including fetal and neonatal death, as well as severe maternal neurologic disorders occurred. Patients with substitution of AT during pregnancy in addition to LMWH showed the best maternal and neonatal outcome. Close monitoring with appropriate anticoagulant treatment including surveillance of AT levels might help to optimize maternal and fetal outcome in patients with hereditary AT deficiency.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Abortion, Habitual / epidemiology
Abortion, Habitual / etiology
Abortion, Habitual / prevention & control
Adult
Anticoagulants / adverse effects
Anticoagulants / therapeutic use*
Antithrombin III / adverse effects
Antithrombin III / analysis
Antithrombin III / therapeutic use*
Antithrombin III Deficiency / blood
Antithrombin III Deficiency / drug therapy*
Antithrombin III Deficiency / genetics
Antithrombin III Deficiency / physiopathology
Drug Therapy, Combination / adverse effects
Female
Fetal Death / epidemiology
Fetal Death / etiology
Fetal Death / prevention & control
Fetal Growth Retardation / epidemiology
Fetal Growth Retardation / etiology
Fetal Growth Retardation / prevention & control
Germany / epidemiology
Heparin / adverse effects
Heparin / therapeutic use*
Heparin, Low-Molecular-Weight / adverse effects
Heparin, Low-Molecular-Weight / therapeutic use*
Hospitals, University
Humans
Mutation
Pre-Eclampsia / epidemiology
Pre-Eclampsia / etiology
Pre-Eclampsia / prevention & control
Pregnancy
Pregnancy Complications / blood
Pregnancy Complications / drug therapy*
Pregnancy Complications / genetics
Pregnancy Complications / physiopathology
Retrospective Studies
Risk Factors
Venous Thromboembolism / epidemiology
Venous Thromboembolism / etiology
Venous Thromboembolism / prevention & control*
Young Adult

Substances

Anticoagulants
Heparin, Low-Molecular-Weight
SERPINC1 protein, human
Antithrombin III
Heparin