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    Poster Networking

    Coagulation and Natural Anticoagulants

    Poster Networking Session

    PB0544 - Management of inherited antithrombin deficiency in pregnancy and puerperium: Single center experience

    Monday, June 26, 2023
    18:30 – 19:30 ET
    Room: Exhibition

      Co-Author(s)

    • AMAIA LOPEZ-PEÑA

      FORTH YEAR RESIDENT IN HEMATOLOGY
      MIGUEL SERVET UNIVERSITARY HOSPITAL
      ZARAGOZA, Aragon, Spain

      • Co-Author(s)

    • MO

      Marta Sofia Ordas

      Resident of Hematology
      MIGUEL SERVET UNIVERSITY HOSPITAL
      ZARAGOZA, Aragon, Spain

    • CR

      Carmen Rodriguez

      Resident of Hematology
      MIGUEL SERVET UNIVERSITARY HOSPITAL
      zaragoza, Aragon, Spain

    • Javier Corral, PhD

      PhD
      Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Pascual Parrilla, CIBERER, Murcia, Spain
      Murcia, Murcia, Spain

    • Maria Eugenia de la Morena-Barrio, PhD

      Reseacher
      Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain
      Murcia, Murcia, Spain

    • MH

      Mar Herrero

      Resident of Hematology
      MIGUEL SERVET UNIVERSITARY HOSPITAL
      Zaragoza, Aragon, Spain

    • PL

      Pablo Estuardo Lopez-Gomez

      Resident of Hematology
      Miguel Servet Universitary Hospital
      Zaragoza, Aragon, Spain

    • RG

      Rita Gonzalez-Resina

      Resident of Hematology
      Miguel Servet Universitary Hospital
      ZARAGOZA, Aragon, Spain

    • JO

      Jhossyuriel Obregon-membreño

      Resident of Hematology
      Miguel Servet Universitary Hospital
      ZARAGOZA, Aragon, Spain

    • LF

      Laura Fernandez-Cuezva

      Resident of Hematology
      Miguel Servet Universitary Hospital
      ZARAGOZA, Aragon, Spain

    • LE

      Leire Etxebarria-Bahillo

      Resident of Hematology
      Miguel Servet Universitary Hospital
      Zaragoza, Aragon, Spain

    • LV

      Laura Villarroya-Martinez

      RESIDENT OF HEMATOLOGY
      MIGUEL SERVET UNIVERSITARY HOSPITAL
      ZARAGOZA, Aragon, Spain

    • Rm

      Rafael monleon-Gil

      RESIDENT OF HEMATOLOGY
      MIGUEL SERVET UNIVERSITARY HOSPITAL
      ZARAGOZA, Aragon, Spain

      • Presenting Author(s)

    • Jose Manuel Calvo-Villas, MD

      Hematology Department
      Miguel Servet Universitary Hospital
      Zaragoza, Aragon, Spain

      • Co-Author(s)

    • Nuria Fernández-Mosteirín, PhD MD

      Hematology Department
      Hospital Universitario Miguel Servet (Zaragoza)
      Zaragoza, Aragon, Spain

    Background: Antithrombin deficiency (ATD) is the most thrombogenic hereditary thrombophilia. Pregnancy and puerperium cause a procoagulant condition. ATD increases the risk of early fetal loss and intrauterine growth restriction (IUGR).

    Aims: To describe the management of ATD during pregnancy and puerperium and analyze obstetric, thrombotic and hemorrhagic complications.

    Methods: Descriptive, observational and retrospective based on pregnant women with hereditary ATD between January 1993 and February 2022 in our center. Demographic and clinical variables, family and personal background, and therapeutic aspects were analyzed.

    Results: We studied 15 pregnancies (13 spontaneous and 2 by assisted reproduction) in 5 women. Median age 34 years (31-35). No women had personal history of thrombosis and two had family history. 6 miscarriages were observed in 3 women. Prior to diagnosis of ATD, 1 patient suffered from massive bilateral pulmonary embolism and deep vein thrombosis (DVT) after a miscarriage (Table 1). Median antithrombin (AT) level in the third trimester 38% (33.7-43). In 6 pregnancies prophylactic low molecular weight heparin (LMWH) was administered until 6 weeks postpartum. Anti-Xa activity was monitored in 5 pregnancies, adjusting the dose of LMWH. In 5 pregnancies, AT replacement therapy was prescribed during birth and 8-48h postpartum. Prior to diagnosis, bilateral iliofemoral DVT was observed in 1 patient after delivery. No thrombotic complications were observed in patients treated with LMWH. 6 births were eutocic and 2 instrumental. 1 birth was a scheduled cesarean section due to IUGR. Mild hemorrhagic complications appeared in 3 pregnancies, resolved with curettage, methylergometrine or reduction of LMWH (Table 2).

    Conclusion(s): Pregnancy in ATD patients increases thrombotic risk and entails high morbi-mortality if thromboprophylaxis is not administered (13.3%). Likewise, there is an increased risk of miscarriage in 40% of pregnancies. Early onset antithrombotic prophylaxis is effective and safe for prevention of thrombotic and obstetric complications.