Management of pregnancy in women with thrombophilia

Hereditary thrombophilia increases the risk of thrombosis during pregnancy and postpartum. The recommendations resulting from the Fifth American Colle ge of Chest Physicians (ACCP) Consensus Conference on Antithrombotic Therap y were published in Chest in late 1998. However, levels of evidence on this subject were low (C2). Furthermore, since publication of this ACCP consens us, new studies have demonstrated the safety of low-molecular-weight hepari ns (LMWHs) in pregnant women. In addition, it is now clear that all thrombo philias are not associated with the same level of thrombotic risk: factor V Leiden mutation and factor II 20210A variant are associated with a lower r isk than antithrombin deficiency. Consequently, the ACCP recommendations ha ve been reconsidered in the light of a more widespread use of LMWH and taki ng into account the differences in the level of risk of the different throm bophilias. A prophylaxis of thrombosis in pregnant women with thrombophilia is proposed based on published data and our personal experience. Although laboratory monitoring is usually not required during treatments with LMWH, it seems to be needed in pregnant women who receive long-term treatments. C opyright (C) 1999 S. Karger AG, Basel.