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THROMBOTIC RISK MANAGEMENT BEFORE AND DURING PREGNANCY

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18
Participantes
13
Comentarios

Thrombotic risk management before and during pregnancy is an important medical issue that should be taken into consideration by gynecologists. 

 

CredoMedia India starts a discussion about this crucial issue. We would like to discuss the following key points:

 

 

  • When is a coagulation status test necessary when a patient is planning  pregnancy or is already pregnant?
  • Are conception and successful carriage of the fetus possible in cases of inherent or acquired thrombophilia?
  • Is thrombophilia an obstacle for assisted reproduction?
  • What is the risk of placental capillaries thrombosis in women with thrombophilia in comparison with women without that condition?
  • What is the effect of auxiliary hormonal treatment on micro- and macro thrombotic risk during assisted reproduction?
  • What are the drug application methods in hypercoagulable state management?
  • Medication administration algorithms of low-molecular heparin
  • Laboratory and clinical control of low-molecule heparin treatment
  • Are there any drug interactions – how are they manifested and managed?
  • The role of combined treatment – low-molecular heparin, acetylsalicylic acid etc.
  • Duration of low-molecular heparin treatment and cases when it is necessary during assisted reproduction or when trying to conceive naturally after a miscarriage

Reglas

We would like to invite all obstetrics and gynecology doctors specialized in assisted reproduction. We would be glad if you would share your opinion, comment or share a case study from your practice.

 

The discussion starts on the 1st of September and will be open for one month. 

18
Participantes
13
Comentarios

Comentarios

11 sep 2018 11:45
CredoMedia
11 sep 2018 11:45


Thrombophilia and Pregnancy

There have been many studies that have addressed the relationship of inherited and acquired TP with adverse pregnancy outcomes (APO) and thrombosis during gestation and postpartum. FV Leiden and PGMG20210A as risk factors for miscarriage during a 1st intended pregnancy. The two mutations increased risk for PL between the 10th to 19th weeks of gestation and FVLeiden increased risk from the 20th through the 39th week of gestation. It is recommended that patients with prior single PL should be tested for these mutations and that low molecular weight heparin be used to increase the chance for successful pregnancy.

Read more here&

https://www.genpathdiagnostics.com/womens-health/pregnancy-thrombophilia/

11 sep 2018 11:37

Traditionally, acute deep venous thrombosis (DVT) is treated with intravenous heparin followed by oral anticoagulants. With the advent of the low-molecular-weight heparins (LMWHs), this strategy is changing dramatically.


Read more in the study

Low-molecular-weight heparin in the treatment of deep venous thrombosis:


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305303/

11 sep 2018 11:23
CredoMedia
11 sep 2018 11:23

More about coalgulation tests and what we should know: 


Clinicians frequently order coagulation tests, such as the prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin time (TT), to assess blood clotting function in patients. While these laboratory tests may be helpful in elucidating the cause of unexplained bleeding, they are not helpful in predicting if bleeding will occur. In fact, no single test can predict bleeding in the perioperative or post-operative period. Furthermore, these common laboratory tests are of little help in predicting blood clotting or thrombosis in the absence of vessel injury. Well-described assays are available to test for hereditary predisposition to thrombosis, but the majority of thrombophilic states cannot be quantified by any current laboratory tests.Clearly, laboratory assessment of hemostasis presents many challenges for laboratorians and the clinicians who interpret the results. This review briefly explains the common tests used to assess hemostasis, as well as their clinical context, and provides a guide for clinical chemists to assess unexplained bleeding. Clearly, laboratory assessment of hemostasis presents many challenges for laboratorians and the clinicians who interpret the results. This review briefly explains the common tests used to assess hemostasis, as well as their clinical context, and provides a guide for clinical chemists to assess unexplained bleeding.

Read more here:

https://www.aacc.org/publications/cln/articles/2012/january/coagulation-tests

11 sep 2018 11:12

Can a blood clot cause problems during delivery? Actually it's the treatment for a blood clot that can cause problems with delivery. What are the possible dangers if you are on blood thinners: 



https://youtu.be/92y3lDLGTCE

11 sep 2018 11:04
CredoMedia
11 sep 2018 11:04

Does fertility therapy increase the risk of longer term cardiovascular outcomes? We are showing here the relation between fertility therapy and cardiovascular disease: 

11 sep 2018 10:59

11 sep 2018 10:56

In pregnancy the uterus can compress the left iliac vein and may explain why DVT is significantly more common on the left side in pregnancy (>80% of cases). DVT is more commonly diagnosed in the pelvic venous system in pregnancy (>60% of cases) compared with the non-pregnant population.

11 sep 2018 10:52

Colleagues, this is an interesting video to see:


https://youtu.be/-Mm3jhq5CtI

11 sep 2018 10:48
CredoMedia
11 sep 2018 10:48

Colleagues, we would like to raise in the discussion the following question: Does fertility therapy increase the risk of longer term cardiovascular outcomes?

11 sep 2018 10:43

The use of assisted reproductive technology (ART) has increased tremendously in the past three decades. During the process of ART, supraphysiological estradiol levels with exogenous hormone administration can result. One major complication of this intervention, Ovarian hyperstimulation syndrome (OHSS), is associated with both arterial and venous thromboembolic complications. Thromboprophylaxis should be considered for patients who develop an OHSS moderate to severe for a prolonged period of 1-2 months beyond the resolution of OHSS clinical, and also be considered for patients with a known thrombophily inherited or acquired while undergoing ART.

11 sep 2018 10:06
CredoMedia
11 sep 2018 10:06

There may be a ticking time bomb in your veins. It's rare, potentially deadly, hereditary, and worst of all, it's most dangerous to expecting and new mothers. It's called Hereditary Antithrombin (AT) Deficiency. It is among the rarest, most dangerous, and most underdiagnosed of all inherited blood clotting disorders. And it's highly unlikely that your OBGYN will test you for it. The statistics are sobering: patients with Hereditary AT Deficiency have a 20-fold higher risk of blood clots, such as deep vein thrombosis (DVT) or pulmonary embolism (PE). One in three pulmonary embolisms may be fatal. Unfortunately, if you're pregnant, the risk increases even further.In fact, up to 70% of women with Hereditary AT Deficiency who do not receive preventative treatment may experience blood clotting before or after the birth.

11 sep 2018 10:04
CredoMedia
11 sep 2018 10:04

See how they solve these issues in Mayo Clinic


https://youtu.be/Uw8hDHuxVSM