437. Controversies in thrombophilia testing & use of newer anticoagulants agents in pregnancy & lactation

Abstract

Saskia Middeldorp will first delve into the association between thrombophilia and complications during pregnancy including recurrent miscarriage and fetal loss, pre-eclampsia/eclampsia, intrauterine growth restriction, and placental abruption. These complications are clinical characteristics of the acquired thrombophilia antiphospholipid syndrome. There is also a modest association of some of these complications with inherited thrombophilia, which include factor V Leiden, prothrombin 20210A mutation and deficiencies of the anticoagulant proteins antithrombin, protein C or protein S. Despite absence of evidence in most situations, the use of antithrombotics with the aim to improve pregnancy outcome is widespread. She will review the evidence supporting or refuting the effectiveness of antithrombotics including aspirin and low-molecular-weight heparin in various clinical scenarios. The second part of the lecture will discuss direct oral anticoagulants (DOACs), also referred to as novel or non-vitamin K antagonist oral anticoagulants (NOACs). These agents are now the recommended drugs of choice for treatment and secondary prevention of venous thromboembolism and atrial fibrillation. These agents are small molecules and hence, pass the placenta. Saskia Middeldorp will discuss the current available data regarding safety of DOACs in pregnancy and lactation, and discuss the management strategies in women who are using DOACs who intend to become pregnant, or have an indication for anticoagulant treatment or prophylaxis in pregnancy.