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P-079 Long term use of low-molecular-weight heparin during pregnancy does not affect postpartum bone mineral density
Abstracts / Thrombosis Research 131, Suppl. 1 (2013) S71–S103
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antiphospholipid antibodies, protein C and S deficiency, trombomodulin defects in groups of risk of the genetic and acquired thrombophilias in obstetric practice and can be used as screening at the first investigation phase. Materials and methods: Research was carried out at three groups of women. The first group consisted on the patients with severe preeclampsia complicated with intrauterine fetal death (n=42), 2nd group – patients with repeated spontaneous miscarriages (3 or more fetal losses), n=75. 3rd group – patients with various thrombotic complications after taking of hormonal oral contraceptives, n=39. Control group – 50 healthy women. In all groups we performed analyses of coagulometric parameters. Results: Protein C global test was pathologic at 49% of patients with severe preeclampsia, at 39% – in patients with fetal loss syndrome, and at 49% of women with thrombotic complications, in control group – in 4%. APCresistance was detected in 21% in 1st group, in 24% in 2nd and in 31% in 3rd group respectively. Conclusion: The results of research specify that APC-resistance and protein C global test are accessible and easy-replicated tests that can be considered as the first stage in definition and determination of risk groups of patients with genetic and acquired thrombophilias.
34 with confirmed venous thromboembolic event (VTE) during index pregnancy, or with previos VTE, were treated with either therapeutic (n=9) or prophylactic (n=25) dose of LMWH for a period longer than 3 months before delivery. Control group consisted of 34 healthy pregnant women. All investigated women had dual energy X-ray absorptiometry (DEXA) scans of lumbar spine (L1–L4) and hip (FT) performed six weeks after delivery. The Z-score was assessed for each investigated woman as the number of standard deviations of bone mineral density (BMD) from reference value mathed for age. Results: There was no difference in age and body mass index between two groups. Lumbar spine (L1–L4) BMD was 1.171 g/cm3 and 1.117 g/cm3 in investigated group and controls respectively (p=0.08). Femur BMD was 0.984 g/cm3 and 0.945 g/cm3 in investigated group and controls respectively (p=0.15). There was also no difference between prophylaxis (L1–L4 1.15 g/cm3 , FT 0.98 g/cm3 ) and therapy (L1–L4 1.13 g/cm3 , FT 0.98 g/cm3 ) subgroups (p=0.85, p=0.22; p=0.84, p=0.86). Likewise, there was no difference in Z-scores between investigated group and controls. Comment: Results of the study indicate that long term exposure to both prophylactic and therapeutic LMWH during pregnancy is not associated with decrease in postpartum bone mineral density.
P-078 Pregnancy-associated changes of clotting and metabolic parameters in women with history of infertility
P-080 Risk of venous thrombosis after Cesarean sections: a meta-analysis
C. Lodigiani 1 , E. Banfi 1 , P. Ferrazzi 1 , L. Librè 1 , I. Quaglia 1 , E. Morenghi 2 , L.L. Rota 1 1 Centro Trombosi, IRCCS, Ist Clinico Humanitas, Milano-Rozzano; 2 Laboratorio di Statistica e Biometria, IRCCS-Ist Clinico Humanitas, Milano-Rozzano, Italy Hemostasis and estrogen-sensitive liver products are influenced by pregnancy and use of hormone in ART. Relationship with risk of obstetrical complications and how using them to monitor it have not yet been established. We describe the trend of PT, aPTT, ddimer, fibrinogen, FVII, FVIII, FXII, homocysteine, protein C, protein S, AT, cholesterol and triglycerides, before pregnancy and every month until the delivery and postpartum, in 170 women (mean age 38±4 ys), 127 infertiles and with repeated implantation failures (107 ART and 20 spontaneous); 43 recurrent miscarriages (13 ART, 30 spontaneous). Usual and previous smokers 2.9% and 4.7%, BMI >25 in 8.2%, 4.1% previous DVT, 1.8% previous arterial thrombosis. We documented evident increasing during pregnancy and decreasing after delivery only in ddimer (230.9±127.5 to 924.3±632.6 ng/ml; 272.8±257.2 ng/ml in PP); FVII (99.4%± 20.7 to 186.6±43.8; 119.8%±21.7 in PP); FVIII (103.3% ±36.3 to 224.0%±72.1%; 139.9%±38.9% in PP); FXII (107.4±28.5% to 172.7±53.8%; 111.4±25.0% in PP); fibrinogen (289.6±56.8 to 490.8±79.6 mg/dl; 324.4±67.3 mg/dl in PP); cholesterol (211.5±32.3 to 331.4±70.8 mg/dl; 249.8±47.5 mg/dl in PP) and triglycerides (145.4±193.2 mg/dl to 283.0±93.2 mg/dl; 98.7±48.6 mg/dl in PP); we noted an evident decrease in protein S (84.7±21.4% to 45.1±10.7%; 62.9±21.7% in PP). We confirm a trend toward a hypercoagulability, due to increase in FVII, FVIII, ddimer and tryglicerides and decrease in protein S, that could be the most rappresentative for vascular placental abnormalities, and should be used to monitor this risk in pregnancy and to establish and justify a fitted antithrombotic therapy.
P-079 Long term use of low-molecular-weight heparin during pregnancy does not affect postpartum bone mineral density 1
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G. Mitic *, A. Novakov-Mikic *, J. Novakovic-Paro , D. Popov , S. Novakovic-Anucin 1 , S. Gnip 1 , V. Canak 1 , D. Spasic 5 , B. Kovacev-Zavisic 3 * 1 Thrombosis and Haemostasis Unit, Department of Laboratory Medicine; 2 Department of Obstetrics and Gynaecology; 3 Department of Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Novi Sad, Serbia; 4 General Hospital “Djordje Joanovic”, Zrenjanin; 5 Department of Mechanics, University of Novi Sad, Serbia *University Medical School, Novi Sad, Serbia Objective: The aim of this prospective case control study was to assess the effect of long term administration of low-molecular-weight heparin (LMWH) during pregnancy on the bone mineral density (BMD). Methods: Sixty eight pregnant women have been included in the study,
M. Blondon 1,5 , L. Harrington 1 , K.K. Hoppe 2 , M. Righini 5 , F. Boehlen 5 , N.L. Smith 1,3,4 , H. Bounameaux 5 1 Department of Epidemiology; 2 Department of Obstetrics and Gynecology, University of Washington, Seattle, USA; 3 Group Health Research Institute, Group Health, Seattle, USA; 4 Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, USA; 5 Division of Angiology and Haemostasis, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland Background: Caesarean section (CS) is a risk factor for venous thrombosis (VT) in the postpartum, compared with vaginal delivery (VD). In this meta-analysis we estimated the relative risk (RR) for this association and the absolute risk of VT following CS. Methods: One abstractor searched MEDLINE/EMBASE/CINAHL (1980–2012) to identify (1) all studies comparing the risk of VT in women with CS to women with VD and (2) all prospective studies evaluating the incidence of postpartum VT after CS. Studies of selected populations (thrombophilia, breech, historical VT) were excluded. Pooled measurements were calculated with a random-effects model. Results: Across 20 studies (case-control = 9; cohort = 11), the pooled RR comparing CS to VD was 4.3 (95% CI 3.3–5.6), with a range of individual estimates between 1.0 and 22.2. When restricting to 7 studies with objective VT diagnoses, a similar RR was found (RR 5.1, 95% CI 3.4–7.6). In 5 studies with multivariate models adjusting for at least maternal age, CS remained a significant VT predictor (RR 3.3, 95% CI 2.5–4.4), but BMI was lacking in most models. We identified 8 prospective studies with VT incidence rates of 0.1–1.3%, with incomplete follow-up during the 6 weeks postpartum in 3/8 studies. The use of thromboprophylaxis was allowed in most studies. The pooled VT risk was 0.47 per 100 CS (95% CI 0.19–0.86). Conclusions: Compared with women with VD, women with CS have a 4-fold increased risk of postpartum VT. An incidence rate of VT was about 1 per 200 was found from limited evidence of prospective cohort studies.
P-081 Interactions between genetic polymorphisms and oral hormone therapy on the risk of venous thrombosis M. Blondon 1,7 , K.L. Wiggins 2 , L. Harrington 1 , G. Li 2 , B. McKnight 3 , B.M. Psaty 1,2,4,5 , N.L. Smith 1,5,6 1 Department of Epidemiology; 2 Department of Medicine; 3 Department of Biostatistics; 4 Department of Health Services, University of Washington, Seattle, USA; 5 Group Health Research Institute, Group Health, Seattle, USA; 6 Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, WA USA; 7 Department of Medicine, Geneva University Hospitals, Geneva, Switzerland Background: Oral hormone therapy (HT) increases the risk of venous thrombosis (VT). Previous limited evidence suggests that the risk of VT due
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antiphospholipid antibodies, protein C and S deficiency, trombomodulin defects in groups of risk of the genetic and acquired thrombophilias in obstetric practice and can be used as screening at the first investigation phase. Materials and methods: Research was carried out at three groups of women. The first group consisted on the patients with severe preeclampsia complicated with intrauterine fetal death (n=42), 2nd group – patients with repeated spontaneous miscarriages (3 or more fetal losses), n=75. 3rd group – patients with various thrombotic complications after taking of hormonal oral contraceptives, n=39. Control group – 50 healthy women. In all groups we performed analyses of coagulometric parameters. Results: Protein C global test was pathologic at 49% of patients with severe preeclampsia, at 39% – in patients with fetal loss syndrome, and at 49% of women with thrombotic complications, in control group – in 4%. APCresistance was detected in 21% in 1st group, in 24% in 2nd and in 31% in 3rd group respectively. Conclusion: The results of research specify that APC-resistance and protein C global test are accessible and easy-replicated tests that can be considered as the first stage in definition and determination of risk groups of patients with genetic and acquired thrombophilias.
34 with confirmed venous thromboembolic event (VTE) during index pregnancy, or with previos VTE, were treated with either therapeutic (n=9) or prophylactic (n=25) dose of LMWH for a period longer than 3 months before delivery. Control group consisted of 34 healthy pregnant women. All investigated women had dual energy X-ray absorptiometry (DEXA) scans of lumbar spine (L1–L4) and hip (FT) performed six weeks after delivery. The Z-score was assessed for each investigated woman as the number of standard deviations of bone mineral density (BMD) from reference value mathed for age. Results: There was no difference in age and body mass index between two groups. Lumbar spine (L1–L4) BMD was 1.171 g/cm3 and 1.117 g/cm3 in investigated group and controls respectively (p=0.08). Femur BMD was 0.984 g/cm3 and 0.945 g/cm3 in investigated group and controls respectively (p=0.15). There was also no difference between prophylaxis (L1–L4 1.15 g/cm3 , FT 0.98 g/cm3 ) and therapy (L1–L4 1.13 g/cm3 , FT 0.98 g/cm3 ) subgroups (p=0.85, p=0.22; p=0.84, p=0.86). Likewise, there was no difference in Z-scores between investigated group and controls. Comment: Results of the study indicate that long term exposure to both prophylactic and therapeutic LMWH during pregnancy is not associated with decrease in postpartum bone mineral density.
P-078 Pregnancy-associated changes of clotting and metabolic parameters in women with history of infertility
P-080 Risk of venous thrombosis after Cesarean sections: a meta-analysis
C. Lodigiani 1 , E. Banfi 1 , P. Ferrazzi 1 , L. Librè 1 , I. Quaglia 1 , E. Morenghi 2 , L.L. Rota 1 1 Centro Trombosi, IRCCS, Ist Clinico Humanitas, Milano-Rozzano; 2 Laboratorio di Statistica e Biometria, IRCCS-Ist Clinico Humanitas, Milano-Rozzano, Italy Hemostasis and estrogen-sensitive liver products are influenced by pregnancy and use of hormone in ART. Relationship with risk of obstetrical complications and how using them to monitor it have not yet been established. We describe the trend of PT, aPTT, ddimer, fibrinogen, FVII, FVIII, FXII, homocysteine, protein C, protein S, AT, cholesterol and triglycerides, before pregnancy and every month until the delivery and postpartum, in 170 women (mean age 38±4 ys), 127 infertiles and with repeated implantation failures (107 ART and 20 spontaneous); 43 recurrent miscarriages (13 ART, 30 spontaneous). Usual and previous smokers 2.9% and 4.7%, BMI >25 in 8.2%, 4.1% previous DVT, 1.8% previous arterial thrombosis. We documented evident increasing during pregnancy and decreasing after delivery only in ddimer (230.9±127.5 to 924.3±632.6 ng/ml; 272.8±257.2 ng/ml in PP); FVII (99.4%± 20.7 to 186.6±43.8; 119.8%±21.7 in PP); FVIII (103.3% ±36.3 to 224.0%±72.1%; 139.9%±38.9% in PP); FXII (107.4±28.5% to 172.7±53.8%; 111.4±25.0% in PP); fibrinogen (289.6±56.8 to 490.8±79.6 mg/dl; 324.4±67.3 mg/dl in PP); cholesterol (211.5±32.3 to 331.4±70.8 mg/dl; 249.8±47.5 mg/dl in PP) and triglycerides (145.4±193.2 mg/dl to 283.0±93.2 mg/dl; 98.7±48.6 mg/dl in PP); we noted an evident decrease in protein S (84.7±21.4% to 45.1±10.7%; 62.9±21.7% in PP). We confirm a trend toward a hypercoagulability, due to increase in FVII, FVIII, ddimer and tryglicerides and decrease in protein S, that could be the most rappresentative for vascular placental abnormalities, and should be used to monitor this risk in pregnancy and to establish and justify a fitted antithrombotic therapy.
P-079 Long term use of low-molecular-weight heparin during pregnancy does not affect postpartum bone mineral density 1
2
3
4
G. Mitic *, A. Novakov-Mikic *, J. Novakovic-Paro , D. Popov , S. Novakovic-Anucin 1 , S. Gnip 1 , V. Canak 1 , D. Spasic 5 , B. Kovacev-Zavisic 3 * 1 Thrombosis and Haemostasis Unit, Department of Laboratory Medicine; 2 Department of Obstetrics and Gynaecology; 3 Department of Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Novi Sad, Serbia; 4 General Hospital “Djordje Joanovic”, Zrenjanin; 5 Department of Mechanics, University of Novi Sad, Serbia *University Medical School, Novi Sad, Serbia Objective: The aim of this prospective case control study was to assess the effect of long term administration of low-molecular-weight heparin (LMWH) during pregnancy on the bone mineral density (BMD). Methods: Sixty eight pregnant women have been included in the study,
M. Blondon 1,5 , L. Harrington 1 , K.K. Hoppe 2 , M. Righini 5 , F. Boehlen 5 , N.L. Smith 1,3,4 , H. Bounameaux 5 1 Department of Epidemiology; 2 Department of Obstetrics and Gynecology, University of Washington, Seattle, USA; 3 Group Health Research Institute, Group Health, Seattle, USA; 4 Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, USA; 5 Division of Angiology and Haemostasis, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland Background: Caesarean section (CS) is a risk factor for venous thrombosis (VT) in the postpartum, compared with vaginal delivery (VD). In this meta-analysis we estimated the relative risk (RR) for this association and the absolute risk of VT following CS. Methods: One abstractor searched MEDLINE/EMBASE/CINAHL (1980–2012) to identify (1) all studies comparing the risk of VT in women with CS to women with VD and (2) all prospective studies evaluating the incidence of postpartum VT after CS. Studies of selected populations (thrombophilia, breech, historical VT) were excluded. Pooled measurements were calculated with a random-effects model. Results: Across 20 studies (case-control = 9; cohort = 11), the pooled RR comparing CS to VD was 4.3 (95% CI 3.3–5.6), with a range of individual estimates between 1.0 and 22.2. When restricting to 7 studies with objective VT diagnoses, a similar RR was found (RR 5.1, 95% CI 3.4–7.6). In 5 studies with multivariate models adjusting for at least maternal age, CS remained a significant VT predictor (RR 3.3, 95% CI 2.5–4.4), but BMI was lacking in most models. We identified 8 prospective studies with VT incidence rates of 0.1–1.3%, with incomplete follow-up during the 6 weeks postpartum in 3/8 studies. The use of thromboprophylaxis was allowed in most studies. The pooled VT risk was 0.47 per 100 CS (95% CI 0.19–0.86). Conclusions: Compared with women with VD, women with CS have a 4-fold increased risk of postpartum VT. An incidence rate of VT was about 1 per 200 was found from limited evidence of prospective cohort studies.
P-081 Interactions between genetic polymorphisms and oral hormone therapy on the risk of venous thrombosis M. Blondon 1,7 , K.L. Wiggins 2 , L. Harrington 1 , G. Li 2 , B. McKnight 3 , B.M. Psaty 1,2,4,5 , N.L. Smith 1,5,6 1 Department of Epidemiology; 2 Department of Medicine; 3 Department of Biostatistics; 4 Department of Health Services, University of Washington, Seattle, USA; 5 Group Health Research Institute, Group Health, Seattle, USA; 6 Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, WA USA; 7 Department of Medicine, Geneva University Hospitals, Geneva, Switzerland Background: Oral hormone therapy (HT) increases the risk of venous thrombosis (VT). Previous limited evidence suggests that the risk of VT due