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How to Manage Venous Thromboembolism Risk during Pregnancy in Patients with Inherited Antithrombin Deficiency?
Laetitia Mauge1,2, Hugo Madar3, Julie Carré4,5
1Service d'Hématologie biologique, AP HP, Hôpital Européen Georges Pompidou, Paris, France.
Thrombosis and Haemostasis
|July 8, 2025
Summary
Inherited antithrombin deficiency (ATD) increases the risk of blood clots, especially during pregnancy. Management requires careful consideration of anticoagulation and antithrombin substitution for safe outcomes.
Area of Science:
- Hematology
- Obstetrics
- Thrombosis Management
Background:
- Inherited antithrombin deficiency (ATD) significantly elevates venous thromboembolic risk.
- Pregnancy further amplifies this risk, necessitating prophylactic measures.
- Current guidelines for thromboprophylaxis in pregnant ATD patients are heterogeneous, with limited supporting literature.
Purpose of the Study:
- To review and propose management strategies for thrombosis prevention in pregnant women with ATD.
- To provide guidance on anticoagulation and antithrombin substitution during pregnancy and postpartum.
- To address the challenges in managing these complex cases.
Main Methods:
- A comprehensive literature review was conducted by the French Society of Thrombosis and Haemostasis (SFTH).
- The review focused on thrombotic risk, anticoagulant therapy, antithrombin concentrates, and peripartum management.
- Propositions for management were developed based on the reviewed literature.
Main Results:
- ATD poses a substantial thrombotic risk, particularly when combined with pregnancy.
- Anticoagulant therapy and antithrombin substitution require careful dosing, monitoring, and timing.
- Peripartum management strategies are crucial for preventing complications.
Conclusions:
- Managing thrombotic prevention in pregnant patients with ATD is complex.
- A multidisciplinary approach involving hematologists, obstetricians, and anesthetists is essential.
- Expert center consultation is recommended for optimal patient care and management.
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