Via practica 1/2023

Practical aspects of the assessment of changes in haemostasis in at-risk pregnant patients

Purpose: Physiological prothrombotic changes developed during pregnancy and postpartum period along with other preexisting risk factors increase the risk of venous thromboembolism (VTE) and pregnancy complications. Based on this fact, in the patients with inherited and acquired thrombophilia, anticoagulant thromboprophylaxis should be considered. The purpose of this study is to point out to the possibilities of the assessment of changes in haemostasis and their use in the management of such treatment. Material and methods: Authors processed the model group of 14 patients with the history of thromboembolic complications, in which the results of anti-Xa activity for low molecular weight heparin (LMWH) and parameters of rotational thromboelastometry (ROTEM) were evaluated. These results were compared with the control group of healthy non-pregnant women. Results: In the course of 4 times intervals of blood sampling during pregnancy, in all selected parameters of ROTEM method (tests EXTEM, INTEM and HEPTEM) we detected the shortening of clotting time (CT) and clot formation time (CFT), as well as the increase in the maximum clot firmness (MCF). However, these results did not completely normalize even after the postpartum period. Conclusion: Termination of anticoagulant thromboprophylaxis in women with the history of thromboembolic and pregnancy complications should be individualized with regards to the actual clinical state and results of the particular patient.

Keywords: at-risk pregnancy, venous thromboembolism, rotational thromboelastometry, anticoagulant thromboprophylaxis, low molecular weight heparin