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Prevention of venous thromboembolism in pregnant women with congenital antithrombin deficiency: a retrospective study of a candidate protocol

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Abstract

Background

The best thromboprophylaxis for pregnant women with congenital antithrombin deficiency (CAD) is controversial.

Objective

To clarify the effectiveness of a protocol for venous thromboembolism (VTE) prevention in pregnant women with CAD.

Methods

Women at high risk of VTE were administered antithrombin concentrate and heparin after conception, whereas those at low risk of VTE were administered heparin alone until delivery. All women received antithrombin concentrate at delivery except for one who was diagnosed with CAD.

Results

Ten women had CAD, including one in the high-risk group and nine in the low-risk group. No women had VTE at delivery as per the protocol for VTE prevention. Almost all women had increased antithrombin activity before delivery followed by maintenance at ≥ 70% due to antithrombin concentrate administration. VTE prophylaxis during and after delivery was successful in all women with CAD. However, one woman in the low-risk group did not receive heparin and developed VTE induced by severe hyperemesis at 9 gestational weeks, before the diagnosis of CAD. Women in the high-risk group received antithrombin concentrate after delivery but had increased D-dimer levels at postpartum.

Conclusions

Our protocol to prevent VTE in pregnant women with CAD is safe and effective.

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Abbreviations

AT:

Antithrombin

CAD:

Congenital AT deficiency

CI:

Confidence interval

CS:

Caesarean section

DVT:

Deep vein thrombosis

GW:

Gestational weeks

LDA:

Low-dose aspirin

LMWH:

Low-molecular-weight heparin

OR:

Odds ratio

PTE:

Pulmonary embolism

UFH:

Unfractionated heparin

VTE:

Venous thromboembolism

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Acknowledgements

The authors thank Enago (www.enago.jp) for the English language review.

Funding

The first author received support from the Japan Blood Products Organization (Tokyo, Japan) to publish this article. https://www.jbpo.or.jp/english/. The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Mamoru Morikawa, Kinuko Nakagawa-Akabane, Takeshi Umazume, Kentaro Chiba, Satoshi Kawaguchi, Michinori Mayama, Yoshihiro Saito & Hidemichi Watari

  2. Department of Clinical Laboratory, Iwate Prefectural Chubu Hospital, Kitakami, Japan

    Masahiro Ieko

  3. Department of Obstetrics and Gynecology, Kansai Medical University, Shinmachi 2-5-1, Hirakata City, Osaka, 573-1010, Japan

    Mamoru Morikawa

Authors
  1. Mamoru Morikawa
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  2. Masahiro Ieko
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Contributions

MMo and wrote the manuscript, conducted the research and contributed to the discussion. MI contributed to the discussion and reviewed/edited the manuscript. KN-A conducted the research and contributed to the discussion. KC, MMa, and YS conducted the research. TU contributed to the discussion and reviewed/edited the manuscript. SK conducted the research and contributed to the discussion. HW contributed to the discussion and reviewed/edited the manuscript. All authors have read and approved the manuscript.

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Correspondence to Mamoru Morikawa.

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Morikawa, M., Ieko, M., Nakagawa-Akabane, K. et al. Prevention of venous thromboembolism in pregnant women with congenital antithrombin deficiency: a retrospective study of a candidate protocol. Int J Hematol 116, 60–70 (2022). https://doi.org/10.1007/s12185-022-03327-7

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  • DOI: https://doi.org/10.1007/s12185-022-03327-7

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