Hüsnü ALPTEKİN, Şeref ULUCAN, Türkan CENGİZ, Refika SELİMOĞLU

Gebelikte kalıtsal trombofili ve tromboprofilaksi

Gebelikte Kalıtsal Trombofili ve TromboprofilaksiAmaç: Kalıtsal trombofilik defekti olan gebelerde yaygın olarak kullanılan antikoagulan tedavilerin maternal venöz tromboembolizm ve olumsuz gebelik sonuçlarına etkisini araştırmaktır.Gereç ve Yöntemler: “Kalıtsal trombofili”, “tromboprofilaksi”, “antikoagulan tedavi”, “gebelik”, “venöz tromboembolizm” anahtar kelimeleri ile literatür taraması yapıldı.Bulgular: Trombofili daha çok venöz olmak üzere arterio venöz trombotik olaylara genetik yatkınlık olmasıdır ve gebelikte risk artar. Gebelikte en sık görülen kalıtsal trombofili nedenleri faktör V Leiden, protrombin ve metilentetrahidrofolat redüktaz gen mutasyonlarıdır. Geçirilmiş venöz tromboemboli öyküsü, antitrombin eksikliği, kombine defekt, homozigot veya birleşik heterozigot faktör V Leiden ve protrombin gen mutasyonları olanlar yüksek riskli hastalardır. Bu hastalarda, antikoagulan tedavi venöz tromboembolizmin önlenmesinde ve tedavisinde endikedir. Trombofili ile tekrarlayan gebelik kaybı, preeklampsi, fetal büyüme kısıtlılığı ve ablasyo plasenta gibi olumsuz gebelik sonuçları arasında nedensel bir ilişki olup olmadığı tartışmalıdır. Retrospektif, vaka-kontrol çalışmalar ılımlı bir ilişki ortaya koyar iken, prospektif kohort çalışmalar ile bu ilişki kanıtlanmamıştır. Sonuç: Kalıtsal trombofilide, VTE öyküsü olanlarda ve yüksek riskli gruplarda uygulanan tromboprofilaksinin özellikle tekrarlayan gebelik kayıpları gibi olumsuz gebelik sonuçlarına etkisini ortaya koymak için kalıtsal trombofilinin düşük riskli subgruplarına yönelik daha geniş hasta gruplarında, prospektif, çift-kör, randomize çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

trombofili, tromboprofilaksi, antikoagulan tedavi, gebelik, venöz tromboembolizm

Hereditary thrombophilia and thromboprophylaxis in pregnancy

Hereditary Thrombophilia and Thromboprophylaxis in PregnancyObjective: To investigate the effect on maternal venous thromboembolism and negative pregnancy outcomes of widely-used anticoagulant treatments in pregnancies with hereditary thrombophilic defect.Material and Methods: A scan of literature was made using the key words of ‘thrombophilia’, ‘thromboprophylaxis’, ‘anticoagulant treatment’, ‘pregnancy’, and ‘venous thromboembolism’.Results: Thrombophilia is a genetic tendency to arterio-venous thrombotic events, primarily venous and in pregnancy the risk is increased. The causes of hereditary thrombophilia, which is most often seen in pregnancy, are factor V Leiden, prothrombin and methylentetrahydrofolate reductase gene mutations. High risk patients are those with a history of venous thromboemboli, antithrombin deficiency, combined defect, homozygote or combined heterozygote factor V Leiden and prothrombin gene mutations. In these patients, anti-coagulant treatment is indicated in the prevention and treatment of venous thromboembolism. It is a matter of debate as to whether or not there is a causal relationship between thrombophilia and negative outcomes of pregnancy such as recurrent miscarriages, pre-eclampsia, fetal growth restriction and placental abruption. While retrospective, case-control studies have determined a moderate relationship, prospective cohort studies have not provided evidence of this relationship. Conclusion: To determine the effect of thromboprophylaxis applied for hereditary thrombophilia in those with a history of VTE or high risk groups, on negative pregnancy outcomes such as recurrent miscarriages in particular, there is a need for prospective, double-blind randomised studies on larger patient groups with sub-groups of low-risk hereditary thrombophilia.

Keywords:

Thrombophilia, thromboprophylaxis, anticoagulant treatment, pregnancy, venous thromboembolism,

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