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Prevention, management and extent of adverse pregnancy outcomes in women with hereditary antithrombin deficiency

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Abstract

Antithrombin (AT) deficiency is a rare hereditary thrombophilia with a mean prevalence of 0.02 % in the general population, associated with a more than ten-fold increased risk of venous thromboembolism (VTE). Within this multicenter retrospective clinical analysis, female patients with inherited AT deficiency were evaluated concerning the type of inheritance and extent of AT deficiency, medical treatment during pregnancy and postpartally, VTE risk as well as maternal and neonatal outcome. Statistical analysis was performed with SPPS for Windows (19.0). A total of 18 pregnancies in 7 patients were evaluated, including 11 healthy newborns ≥37th gestational weeks (gw), one small for gestational age premature infant (25th gw), two late-pregnancy losses (21st and 28th gw) and four early miscarriages. Despite low molecular weight heparin (LMWH) administration, three VTE occurred during pregnancy and one postpartally. Several adverse pregnancy outcomes occurred including fetal and neonatal death, as well as severe maternal neurologic disorders occurred. Patients with substitution of AT during pregnancy in addition to LMWH showed the best maternal and neonatal outcome. Close monitoring with appropriate anticoagulant treatment including surveillance of AT levels might help to optimize maternal and fetal outcome in patients with hereditary AT deficiency.

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Conflicts of interest statement/financial support/informed consent

The authors declare that they have no conflict of interest or financial support. This manuscript is an original work not previously published in any substantial part and not under consideration of publication elsewhere. As well, the manuscript has been read and approved for submission by all qualified authors.

Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Ludwig-Maximilians University—Großhadern, Marchioninistrasse 15, 81377, Munich, Germany

    Nina Rogenhofer & Christian J. Thaler

  2. Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany

    Michael K. Bohlmann

  3. Department of Obstetrics and Gynecology, Krankenhaus Salem, Zeppelinstr. 11-33, 69121, Heidelberg, Germany

    Petra Beuter-Winkler

  4. Kinderwunsch Centrum München/Tagesklinik, Lortzingstr. 26, 81241, Munich, Germany

    Wolfgang Würfel

  5. Department of Haematology, Klinikum Augsburg, Stenglinstr. 2, 86157, Augsburg, Germany

    Andreas Rank

  6. Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karls University, Voßstr. 9, 69115, Heidelberg, Germany

    Bettina Toth

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  1. Nina Rogenhofer
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  2. Michael K. Bohlmann
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  3. Petra Beuter-Winkler
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  4. Wolfgang Würfel
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  5. Andreas Rank
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  6. Christian J. Thaler
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  7. Bettina Toth
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Correspondence to Nina Rogenhofer.

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Rogenhofer, N., Bohlmann, M.K., Beuter-Winkler, P. et al. Prevention, management and extent of adverse pregnancy outcomes in women with hereditary antithrombin deficiency. Ann Hematol 93, 385–392 (2014). https://doi.org/10.1007/s00277-013-1892-0

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  • DOI: https://doi.org/10.1007/s00277-013-1892-0

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