Thrombophilia and women's health:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2006
|
| Schriftenreihe: | Obstetrics and gynecology clinics of North America
33,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVI S., S. 347 - 513 Ill., graph. Darst. |
| ISBN: | 1416038949 |
Internformat
MARC
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| 245 | 1 | 0 | |a Thrombophilia and women's health |c guest ed. Isaac Blickstein |
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| 490 | 1 | |a Obstetrics and gynecology clinics of North America |v 33,3 | |
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| 650 | 7 | |a Zwangerschap |2 gtt | |
| 650 | 4 | |a Frau | |
| 650 | 4 | |a Blood coagulation disorders in pregnancy | |
| 650 | 4 | |a Pregnancy Complications | |
| 650 | 4 | |a Thrombophilia | |
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| 999 | |a oai:aleph.bib-bvb.de:BVB01-014990061 | ||
Datensatz im Suchindex
| _version_ | 1804135648174538752 |
|---|---|
| adam_text | THROMBOPHILIA AND WOMEN S HEALTH
CONTENTS
Foreword xiii
William F. Rayburn
Preface xv
Isaac Blickstein
Thrombophilia and Women s Health: An Overview 347
Isaac Blickstein
Thrombophilia, whether inherited or acquired, is one of the hot
topics in women s health. Several factors, some of which are specific
to the female patient, enhance thrombus formation in the presence
of thrombophilia and include oral contraception, hormone replace¬
ment therapy, pregnancy, and puerperium. Thrombotic events are
not only restricted to venous thromboembolism but also are be¬
lieved to cause repeated embryonic loss, fetal loss, placental abrup¬
tion, intrauterine growth restriction, and severe pre eclampsia. It
seems that some thrombophilias, and a combination of thrombo
philic factors, carry a greater risk than others for a given adverse
outcome. The addition of low molecular weight heparin to the
armamentarium was associated with conceptual change in the
practice of anticoagulation. Care should be exercised in the inter¬
pretation of various risks and the potential of anticoagulation as
a remedy to reduce that risk.
Inherited Thrombophilias 357
Michiel Coppens, Stef P. Kaandorp, and Saskia Middeldorp
Many inherited thrombophilias have been detected and the patho
physiologic insight has increased tremendously during the last dec¬
ades. Despite, however, the overwhelming observational evidence
on the association between inherited thrombophilia and several
women s health issues, including VTE, thus far the implications
for clinical practice are uncertain. Although there is firm epidemi
ologic evidence that is helpful in counseling women who have
VOLUME 33 • NUMBER 3 • SEPTEMBER 2006 vii
inherited thrombophilia to prevent a first or recurrent VTE, the
uncertainty is particularly present for women who have other
pregnancy complications, such as recurrent pregnancy loss and
pre eclampsia. For this group, well designed placebo controlled
trials to assess the harm benefit ratio are urgently needed.
Acquired Thrombophilia during Pregnancy 375
Francesco Dentali and Mark Crowther
The principal acquired thrombophilic states include antiphospholi
pid antibody syndrome (APS) and hyperhomocysteinemia (HHC).
APS is a common cause of thrombosis and may cause pregnancy
complications such as recurrent pregnancy loss, pre eclampsia
and intrauterine growth restriction. Anticoagulant therapy is the
mainstay of treatment for patients with APS. However, anticoagu¬
lants are generally contraindicated during pregnancy because they
are potentially teratogenic. Aspirin and prophylactic dose UFH or
LMWH appear to be a safer alternative in these patients. HHC can
be caused by genetic or environmental factors and is considered
a risk factor for thrombosis. Vitamin supplementation reduces
homocysteine levels in most patients, but there is little evidence
that this reduction is associated with a reduction in the risk of com¬
plications. Whether vitamin therapy reduces the risk of other preg¬
nancy complications is unknown.
Screening for Thrombophilia 389
Dorit Blickstein
Thrombophilia screening may be useful in patients at high risk of
VTE because it may improve clinical outcome. Family screening al¬
lows primary prophylaxis for high risk situations and counseling
of women considering hormonal therapy and pregnancy. Until
we find useful and inexpensive screening tools, it is not recom¬
mended to test every patient or her/his relatives. Each index case
should be carefully evaluated by an expert physician who should
tailor the laboratory testing and treatment modalities.
Monitoring the Effects and Managing the Side Effects
of Anticoagulation during Pregnancy 397
Jean Christophe Gris, Geraldine Lissalde Lavigne,
Isabelle Quere, and Pierre Mares
Anticoagulant therapy is given to pregnant women for the treat¬
ment or prevention of venous thromboembolism (VTE) and for sec¬
ondary prevention of some adverse pregnancy outcomes in case of
biological predisposition. Anticoagulation is also used for the pre¬
vention of systemic embolism in women with mechanical heart
valves. Vitamin K antagonists cross the placenta, are teratogenic
when given up to the sixth week of gestation, may induce embryo
pathy and central nervous system abnormalities, and should be
avoided during the weeks preceding delivery due to potential
™ CONTENTS
bleeding complications. Low molecular weight heparins, which
seem to be safe and effective for the prevention or treatment of
VTE in pregnancy, have replaced unfractionated heparins in
women who have normal renal function. Their monitoring, when
indicated, is based on antifactor Xa plasma activity. Their main
complications are bleeding, skin allergic reactions, heparin induced
thrombocytopenia, and osteoporosis.
Thrombophilia and the Risk for Venous
Thromboembolism during Pregnancy, Delivery,
and Puerperium 413
Scott M. Nelson and Ian A. Greer
The main inherited thrombophilias (antithrombin deficiency, pro¬
tein C and S deficiency, Factor V Leiden ([FVL]), the prothrombin
gene variant, and MTHFR C677T homozygotes) have a combined
prevalence in Western European populations of 15% to 20%. One
or more of these inherited thrombophilias is usually found in ap¬
proximately 50% of women who have a personal history of ve¬
nous thromboembolism (VTE). Obstetricians must therefore be
aware of the interaction between thrombophilias and the procoa
gulant state of pregnancy and have an understanding of additional
risk factors that may act synergistically with thrombophilias to
induce VTE. Such knowledge combined with the appropriate use
of thromboprophylaxis and treatment in women who have objec¬
tively confirmed VTE continue to improve maternal and perinatal
outcomes.
Thrombophilia and Recurrent Pregnancy Loss 429
Howard J.A. Carp
Thrombophilias seem to be associated with, and may even cause
some cases of pregnancy loss. However, the role of treatment re¬
mains to be determined, as currently there is little good evidence
of effect. There is a serious ethical dilemma, as to whether treat¬
ment that may be effective should be denied to patients with nu¬
merous prior pregnancy losses. It is strongly suggested that
when treatment fails, the embryo should be karyotyped to exclude
chromosomal aberrations.
Thrombophilia and Adverse Pregnancy Outcome 443
Benjamin Brenner
This article focuses on the clinical evaluation and management
of women who have thrombophilia related placental vascular com¬
plications, including fetal loss, pre eclampsia, intrauterine fetal
growth restriction, and placental abruption. All are major causes
of maternal and fetal adverse outcomes.
CONTENTS «
Fetal and Neonatal Thrombophilia 457
Gili Kenet and Ulrike Nowak Gottl
Thrombophilia of the fetus and neonate may contribute to higher
prevalence of perinatal thrombosis. Due to the potential interaction
between thrombophilic risk factors of the neonate and maternal
thrombophilia and placental vasculopathy, we suggest thrombo¬
philia assessment be performed in any child and in the mother in
case of perinatal thrombosis. Further attention and larger prospec¬
tive studies are required to establish the role of thrombophilic risk
factors in the pathogenesis of perinatal complications.
Exogenous Sex Hormones and Thrombophilia 467
Isobel D. Walker
Worldwide, hundreds of millions of women use exogenous estro¬
gens in contraceptives or for postmenopausal hormone replace¬
ment. Exogenous estrogens increase the risk for venous and
arterial thrombosis. This article reviews the use of exogenous sex
hormones in women with thrombophilia.
The Obstetrical Patient with a Prosthetic Heart Valve 481
Stephan Danik and Valentin Fuster
The management of a pregnant woman who has a prosthetic heart
valve requires important considerations in deciding how to main¬
tain anticoagulation. Because there are little prospective data, one
cannot make definitive recommendations for each patient. Therapy
must be individualized because there are known risks to the mother
and her fetus regardless of whether warfarin, unfractionated
heparin, or low molecular weight heparin (LMWH), or some com¬
bination of the three, is used. Although initially seen as a possible
advance in preventing thromboembolism, the use of LMWH in this
clinical setting has not been definitively evaluated. In this article,
the historical controversies over the use of warfarin and subcuta¬
neous unfractionated heparin are discussed in detail. Also, the
most recent evolution of the debate concerning the use of LMWH
in this setting is discussed. An understanding of the most current
data is critical in helping the patient and the clinician decide on
the appropriate strategy for anticoagulation.
Peripartum and Perioperative Management
of the Anticoagulated Patient 493
Stephen T. Chasen
Management of the pregnant patient requiring anticoagulation in
the peripartum period represents a significant clinical challenge.
The peripartum period includes the most thrombogenic pregnancy
associated state and the intrapartum and immediate postpartum
periods, when hemorrhage is an important concern. Clinical
decisions depend on the type of antepartum anticoagulation,
x CONTENTS
obstetric factors, risk of hemorrhage, and the risk and implications
of thrombosis.
The Seventh American College of Chest Physicians
Guidelines for the Antenatal and Peripartum
Management of Thrombophilia: A Tutorial 499
Dorit Blickstein
The latest guidelines for the prevention of venous thromboembo
lism were published by the American College of Chest Physicians
in September 2004. This set of updated guidelines represents a dis¬
cussion of treatments of venous thrombosis, thromboprophylaxis,
and a revision of those published in 2001. These guidelines propose
some official recommendations for health care providers for
women during the peripartum period. The purpose of this article
is to settle some ambiguity and to present these recommendations
in a clinical format.
Index 507
CONTENTS *i
|
| adam_txt |
THROMBOPHILIA AND WOMEN'S HEALTH
CONTENTS
Foreword xiii
William F. Rayburn
Preface xv
Isaac Blickstein
Thrombophilia and Women's Health: An Overview 347
Isaac Blickstein
Thrombophilia, whether inherited or acquired, is one of the hot
topics in women's health. Several factors, some of which are specific
to the female patient, enhance thrombus formation in the presence
of thrombophilia and include oral contraception, hormone replace¬
ment therapy, pregnancy, and puerperium. Thrombotic events are
not only restricted to venous thromboembolism but also are be¬
lieved to cause repeated embryonic loss, fetal loss, placental abrup¬
tion, intrauterine growth restriction, and severe pre eclampsia. It
seems that some thrombophilias, and a combination of thrombo
philic factors, carry a greater risk than others for a given adverse
outcome. The addition of low molecular weight heparin to the
armamentarium was associated with conceptual change in the
practice of anticoagulation. Care should be exercised in the inter¬
pretation of various risks and the potential of anticoagulation as
a remedy to reduce that risk.
Inherited Thrombophilias 357
Michiel Coppens, Stef P. Kaandorp, and Saskia Middeldorp
Many inherited thrombophilias have been detected and the patho
physiologic insight has increased tremendously during the last dec¬
ades. Despite, however, the overwhelming observational evidence
on the association between inherited thrombophilia and several
women's health issues, including VTE, thus far the implications
for clinical practice are uncertain. Although there is firm epidemi
ologic evidence that is helpful in counseling women who have
VOLUME 33 • NUMBER 3 • SEPTEMBER 2006 vii
inherited thrombophilia to prevent a first or recurrent VTE, the
uncertainty is particularly present for women who have other
pregnancy complications, such as recurrent pregnancy loss and
pre eclampsia. For this group, well designed placebo controlled
trials to assess the harm benefit ratio are urgently needed.
Acquired Thrombophilia during Pregnancy 375
Francesco Dentali and Mark Crowther
The principal acquired thrombophilic states include antiphospholi
pid antibody syndrome (APS) and hyperhomocysteinemia (HHC).
APS is a common cause of thrombosis and may cause pregnancy
complications such as recurrent pregnancy loss, pre eclampsia
and intrauterine growth restriction. Anticoagulant therapy is the
mainstay of treatment for patients with APS. However, anticoagu¬
lants are generally contraindicated during pregnancy because they
are potentially teratogenic. Aspirin and prophylactic dose UFH or
LMWH appear to be a safer alternative in these patients. HHC can
be caused by genetic or environmental factors and is considered
a risk factor for thrombosis. Vitamin supplementation reduces
homocysteine levels in most patients, but there is little evidence
that this reduction is associated with a reduction in the risk of com¬
plications. Whether vitamin therapy reduces the risk of other preg¬
nancy complications is unknown.
Screening for Thrombophilia 389
Dorit Blickstein
Thrombophilia screening may be useful in patients at high risk of
VTE because it may improve clinical outcome. Family screening al¬
lows primary prophylaxis for high risk situations and counseling
of women considering hormonal therapy and pregnancy. Until
we find useful and inexpensive screening tools, it is not recom¬
mended to test every patient or her/his relatives. Each index case
should be carefully evaluated by an expert physician who should
tailor the laboratory testing and treatment modalities.
Monitoring the Effects and Managing the Side Effects
of Anticoagulation during Pregnancy 397
Jean Christophe Gris, Geraldine Lissalde Lavigne,
Isabelle Quere, and Pierre Mares
Anticoagulant therapy is given to pregnant women for the treat¬
ment or prevention of venous thromboembolism (VTE) and for sec¬
ondary prevention of some adverse pregnancy outcomes in case of
biological predisposition. Anticoagulation is also used for the pre¬
vention of systemic embolism in women with mechanical heart
valves. Vitamin K antagonists cross the placenta, are teratogenic
when given up to the sixth week of gestation, may induce embryo
pathy and central nervous system abnormalities, and should be
avoided during the weeks preceding delivery due to potential
™ CONTENTS
bleeding complications. Low molecular weight heparins, which
seem to be safe and effective for the prevention or treatment of
VTE in pregnancy, have replaced unfractionated heparins in
women who have normal renal function. Their monitoring, when
indicated, is based on antifactor Xa plasma activity. Their main
complications are bleeding, skin allergic reactions, heparin induced
thrombocytopenia, and osteoporosis.
Thrombophilia and the Risk for Venous
Thromboembolism during Pregnancy, Delivery,
and Puerperium 413
Scott M. Nelson and Ian A. Greer
The main inherited thrombophilias (antithrombin deficiency, pro¬
tein C and S deficiency, Factor V Leiden ([FVL]), the prothrombin
gene variant, and MTHFR C677T homozygotes) have a combined
prevalence in Western European populations of 15% to 20%. One
or more of these inherited thrombophilias is usually found in ap¬
proximately 50% of women who have a personal history of ve¬
nous thromboembolism (VTE). Obstetricians must therefore be
aware of the interaction between thrombophilias and the procoa
gulant state of pregnancy and have an understanding of additional
risk factors that may act synergistically with thrombophilias to
induce VTE. Such knowledge combined with the appropriate use
of thromboprophylaxis and treatment in women who have objec¬
tively confirmed VTE continue to improve maternal and perinatal
outcomes.
Thrombophilia and Recurrent Pregnancy Loss 429
Howard J.A. Carp
Thrombophilias seem to be associated with, and may even cause
some cases of pregnancy loss. However, the role of treatment re¬
mains to be determined, as currently there is little good evidence
of effect. There is a serious ethical dilemma, as to whether treat¬
ment that may be effective should be denied to patients with nu¬
merous prior pregnancy losses. It is strongly suggested that
when treatment fails, the embryo should be karyotyped to exclude
chromosomal aberrations.
Thrombophilia and Adverse Pregnancy Outcome 443
Benjamin Brenner
This article focuses on the clinical evaluation and management
of women who have thrombophilia related placental vascular com¬
plications, including fetal loss, pre eclampsia, intrauterine fetal
growth restriction, and placental abruption. All are major causes
of maternal and fetal adverse outcomes.
CONTENTS «
Fetal and Neonatal Thrombophilia 457
Gili Kenet and Ulrike Nowak Gottl
Thrombophilia of the fetus and neonate may contribute to higher
prevalence of perinatal thrombosis. Due to the potential interaction
between thrombophilic risk factors of the neonate and maternal
thrombophilia and placental vasculopathy, we suggest thrombo¬
philia assessment be performed in any child and in the mother in
case of perinatal thrombosis. Further attention and larger prospec¬
tive studies are required to establish the role of thrombophilic risk
factors in the pathogenesis of perinatal complications.
Exogenous Sex Hormones and Thrombophilia 467
Isobel D. Walker
Worldwide, hundreds of millions of women use exogenous estro¬
gens in contraceptives or for postmenopausal hormone replace¬
ment. Exogenous estrogens increase the risk for venous and
arterial thrombosis. This article reviews the use of exogenous sex
hormones in women with thrombophilia.
The Obstetrical Patient with a Prosthetic Heart Valve 481
Stephan Danik and Valentin Fuster
The management of a pregnant woman who has a prosthetic heart
valve requires important considerations in deciding how to main¬
tain anticoagulation. Because there are little prospective data, one
cannot make definitive recommendations for each patient. Therapy
must be individualized because there are known risks to the mother
and her fetus regardless of whether warfarin, unfractionated
heparin, or low molecular weight heparin (LMWH), or some com¬
bination of the three, is used. Although initially seen as a possible
advance in preventing thromboembolism, the use of LMWH in this
clinical setting has not been definitively evaluated. In this article,
the historical controversies over the use of warfarin and subcuta¬
neous unfractionated heparin are discussed in detail. Also, the
most recent evolution of the debate concerning the use of LMWH
in this setting is discussed. An understanding of the most current
data is critical in helping the patient and the clinician decide on
the appropriate strategy for anticoagulation.
Peripartum and Perioperative Management
of the Anticoagulated Patient 493
Stephen T. Chasen
Management of the pregnant patient requiring anticoagulation in
the peripartum period represents a significant clinical challenge.
The peripartum period includes the most thrombogenic pregnancy
associated state and the intrapartum and immediate postpartum
periods, when hemorrhage is an important concern. Clinical
decisions depend on the type of antepartum anticoagulation,
x CONTENTS
obstetric factors, risk of hemorrhage, and the risk and implications
of thrombosis.
The Seventh American College of Chest Physicians
Guidelines for the Antenatal and Peripartum
Management of Thrombophilia: A Tutorial 499
Dorit Blickstein
The latest guidelines for the prevention of venous thromboembo
lism were published by the American College of Chest Physicians
in September 2004. This set of updated guidelines represents a dis¬
cussion of treatments of venous thrombosis, thromboprophylaxis,
and a revision of those published in 2001. These guidelines propose
some "official" recommendations for health care providers for
women during the peripartum period. The purpose of this article
is to settle some ambiguity and to present these recommendations
in a clinical format.
Index 507
CONTENTS *i |
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| indexdate | 2024-07-09T20:43:50Z |
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| isbn | 1416038949 |
| language | English |
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| spelling | Thrombophilia and women's health guest ed. Isaac Blickstein Philadelphia [u.a.] Saunders 2006 XVI S., S. 347 - 513 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Obstetrics and gynecology clinics of North America 33,3 Trombose gtt Zwangerschap gtt Frau Blood coagulation disorders in pregnancy Pregnancy Complications Thrombophilia Thrombosis Women Blickstein, Isaac 1953- Sonstige (DE-588)1259846903 oth Obstetrics and gynecology clinics of North America 33,3 (DE-604)BV000617486 33,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=014990061&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Thrombophilia and women's health Obstetrics and gynecology clinics of North America Trombose gtt Zwangerschap gtt Frau Blood coagulation disorders in pregnancy Pregnancy Complications Thrombophilia Thrombosis Women |
| title | Thrombophilia and women's health |
| title_auth | Thrombophilia and women's health |
| title_exact_search | Thrombophilia and women's health |
| title_exact_search_txtP | Thrombophilia and women's health |
| title_full | Thrombophilia and women's health guest ed. Isaac Blickstein |
| title_fullStr | Thrombophilia and women's health guest ed. Isaac Blickstein |
| title_full_unstemmed | Thrombophilia and women's health guest ed. Isaac Blickstein |
| title_short | Thrombophilia and women's health |
| title_sort | thrombophilia and women s health |
| topic | Trombose gtt Zwangerschap gtt Frau Blood coagulation disorders in pregnancy Pregnancy Complications Thrombophilia Thrombosis Women |
| topic_facet | Trombose Zwangerschap Frau Blood coagulation disorders in pregnancy Pregnancy Complications Thrombophilia Thrombosis Women |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=014990061&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| volume_link | (DE-604)BV000617486 |
| work_keys_str_mv | AT blicksteinisaac thrombophiliaandwomenshealth |