Hypercoaguable Conditions & Thrombophilia
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Counsel on Increased Risk with Pregnancy
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Pregnancy, and particularly the postpartum state, increases the risk for and
incidence of thrombosis, even in women without hypercoaguable conditions or
thrombophilias.
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Antiphospholipid antibody syndrome increases the risk for thrombosis and
thrombocytopenia. During pregnancy there is an increased risk for stroke,
gestational hypertension, stillbirth, recurrent miscarriage, birth restriction and
preterm birth.
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There is a significant association between venous thromboembolism (VTE) during pregnancy and the following thrombophilias: Factor V Leiden, PT G20210A, and antithrombin III deficiency. Women homozygous for these mutations generally receive anticoagulation therapy in pregnancy.
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Inform women heterozygous for a single mutation that their absolute risk for VTE in pregnancy is low (0.5 to 1.2%) and that most women with thrombophilias have normal pregnancy outcomes.
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Thrombophilic defects are more prevalent in women with recurrent first trimester
pregnancy loss.
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Thrombophilias increase the risk for late fetal loss (after 10 weeks gestation).
Thrombophilias are more strongly associated with pregnancy loss after 10 weeks
gestation.
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Contraception Counseling
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Intrauterine or sub-dermal contraceptives are preferred.
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Personal history of deep venous thrombosis or pulmonary embolism: avoid
estrogen-containing contraceptives (Superficial venous thrombosis is not an
absolute contraindication to estrogen use).
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Thrombogenic homozygous mutation (factor V Leiden, PT G20210A, and antithrombin III
deficiency): avoid estrogen-containing contraceptives.
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Routinely assess and confirm the use of effective contraception.
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