15. Inherited and Acquired Thrombophilias

  1. John T. Queenan MD1,
  2. Catherine Y. Spong MD2 and
  3. Charles J. Lockwood MD3
  1. Michael J. Paidas MD

Published Online: 4 JAN 2012

DOI: 10.1002/9781119963783.ch15

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

How to Cite

Paidas, M. J. (2012) Inherited and Acquired Thrombophilias, in Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition (eds J. T. Queenan, C. Y. Spong and C. J. Lockwood), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119963783.ch15

Editor Information

  1. 1

    Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA

  2. 2

    Bethesda, MD, USA

  3. 3

    Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Author Information

  1. Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Publication History

  1. Published Online: 4 JAN 2012
  2. Published Print: 24 FEB 2012

ISBN Information

Print ISBN: 9780470655764

Online ISBN: 9781119963783

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Keywords:

  • inherited and acquired thrombophilias;
  • predominant thrombophilic mutations;
  • FVL mutation, and PGM;
  • hemostatic changes in pregnancy;
  • changes in natural anticoagulant, fibrinolytic systems;
  • hemostatic changes in pregnancy;
  • inherited thrombophilias, and venous thromboembolism;
  • abruptio placentae, and thrombophilia and abruption, challenging;
  • antithrombin deficiency;
  • screening, inherited and acquired thrombophilia

Summary

Thrombophilias present an evolving, controversial story. Predominant thrombophilic mutations include the factor V Leiden mutation, prothrombin G20210A gene mutation, and deficiencies of the natural anticoagulants proteins C and S, and antithrombin. Prospective cohort studies have provided an accurate assessment of the risk for placenta-mediated complications posed by common inherited thrombophilic conditions. Acquired thrombophilic conditions consist of the antiphospholipid antibody syndrome and hyperhomocysteinemia. Well-conducted, placebo-controlled, randomized trials have demonstrated no benefit of anticoagulation in women with recurrent pregnancy loss and inherited thrombophilia. The routine use of anticoagulation to prevent other placenta-mediated complications in the setting of inherited thrombophilia should be considered experimental until the results of adequate clinical trials are available. Heparin and antiplatelet therapy are the cornerstones of treatment of antiphospholipid antibody syndrome in pregnancy.