Management issues in other thrombophilia Ng Heng Joo Department of Haematology Singapore General Hospital.

Slides:



Advertisements
Similar presentations
Venous Thrombo-embolism In Pregnancy
Advertisements

Thrombophilia screening
Thromboprophylaxis after delivery
Venous Thromboembolism: Risk Assessment and Prophylaxis
Indications for a thrombophilia workup in Obstetrics Helen H. Kay, MD February, 2005.
1 Classification n APS, n Hereditary Thrombophilias, n Unexplained RPL,
1 THROMBOPHILIA. 2 Thrombophilia is technical term for hypercoagulable state Thrombosis (arterial or venous) is produced by a shift in the balance between.
Thrombophilia. Now considered a multicausal disease, with an interplay of acquired and genetic thrombotic risk factors Approximately half of venous thromboembolic.
Venous Thromboembolism: Risk Assessment and Prophylaxis
Increasingly, women who are asymptomatic present in pregnancy with a known thrombophilia, typically detected because of screening following identification.
Below the Knee DVT and Pregnancy Related Thrombosis Robert Lampman, MD Morning Report July 2009.
Week 7: Fibrinolysis and Thrombophilia Secondary fibrinolysis Secondary fibrinolysis Primary fibrinolysis Primary fibrinolysis Plasminogen Plasminogen.
CHEST-2012: High Points and Pearls Alan Brush, MD, FACP Chief, Anticoagulation Management Service Harvard Vanguard Medical Associates.
Venous thromboembolism: how long to treat?
Deep vein thrombosis. Color duplex scan of DVT Venogram shows DVT.
LIFEBLOOD THE Thrombosis CHARITY Venous thromboembolism – Treatment and secondary prevention Ulcus cruris Chronic PE PE DVT Post-thrombotic syndrome Death.
Volume 359: November 6, 2008 Number 19November 6, 2008.
Thrombophilia For the Clinician
Thrombophilias Sharon Sams. Objectives Overview of etiology of hypercoagulability Available tests Clinical correlation or “What do I do with these results?”
Dr Nico Lategan MBChB, MMed (Haematology)
Extended Anticoagulation in VTE Geoffrey Barnes, MD Cardiovascular and Vascular Medicine University of Michigan, USA 1 st Qatar Conference on Safe Anticoagulation.
Anticoagulant therapy in RPL Dr. Z. Heidar Assistant professor SBMU.
Chapter Ten Venous Disease Coalition Hypercoagulability VTE Toolkit.
Management thrombophilia. introduction Twenty percent of maternal deaths in the United States during that period were attributed to PE. Inherited thrombophilias.
Bob Silver, MD University of Utah Health Sciences Thrombophilias in Obstetrics Modified from a presentation to the Society of Maternal Fetal Medicine by.
Supervisor: Vs 余垣斌 Presenter: CR 周益聖. INTRODUCTION.
Thromboprophylaxis in Pregnancy and the Puerperium
Max Brinsmead MB BS PhD May A summary of...  RCOG Green-top Guideline number 17 April 2011  “The Investigation and Treatment of Couples with Recurrent.
DEFINING THE DURATION OF ANTICOAGULATION. HOW LONG TO TREAT A DVT?
Hypercoagulable Syndromes. Risk Factors For Venous Thrombosis ACQUIREDINHERITEDMIXED/UNKNOWN Advancing ageAntithrombin Deficiency  Homocysteine ObesityProtein.
Pulmonary Embolism Treatment in Cancer - Is It Different 34th Brazilian Thoracic Conference 6th ALAT Congress 5th Brazil-Portugal Congress Brazilia/DF.
Thrombophilia National Haemophilia Director
Hypercoagulable States. Acquired versus inherited Acquired versus inherited “Provoked” vs idiopathic VTE “Provoked” vs idiopathic VTE Who should be tested.
Thrombophilia (Hypercoagulable States) Abdulkareem Almomen, MD Professor of Medicine & Hematology, King Saud University MED 341, Feb.2014.
Thrombophilia. Definition –Tendency to develop clots due to predisposing factors that may be genetically determined.
Charles J. Lockwood, M.D. The Anita O’Keefe Young Professor and Chair Department of Obstetrics, Gynecology and Reproductive Sciences Yale University School.
Welcome Applicants!! Welcome Applicants!! Morning Report Friday, October 28 th.
A Randomized Trial of Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism Schulman S et al. Proc ASH 2011;Abstract 205.
Dose-Escalated Low Molecular Weight Heparin Provides Effective Anticoagulation for Women with Mechanical Heart Valves During Pregnancy: A Single-Centre.
Risk Assessment for VTE. Which of the following best describes you?
Venous thromboembolic disease
VTE in OBGYN practice DR ANBU SUBBIAN
Previous thrombotic events? aspirin + LMW(H) * long-term use of low dose aspirin? YES aspirin; consider + (LMW)H * LMW(H) * LMW(H) * ; oral anticoagulants.
Thrombophilia Made Simple for Obstetricians
THROMBOPHILIA IN PREGNANCY Rukset Attar, MD, PhD Obstetrics and Gynecology Department.
Postpartum period in women with systemic lupus erythematosus BY DR KH ELMIZADEH.
VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy Shannon M. Bates, MDCM, MSc Ian A. Greer, MD, FMedSci, FCCP Saskia Middeldorp, MD, PhD David.
Venous Thromboembolism (VTE) Prophylaxis at Cesarean Section Phillip N. Rauk, MD.
Antithrombotic Therapy for VTE: CHEST Guidelines 2016
Introduction  Background  Components of thrombophilia tests  Who and when to test  Pitfalls in testing  Specific Management issues (contraception/HRT/travel/pregnancy)
N ENGL J MED 호흡기내과 R1 윤수진 SCREENING FOR OCCULT CANCER IN UNPROVOKED VENOUS THROMBOEMBOLISM.
Six Months vs Extended Oral Anticoagulation After a First Episode of Pulmonary Embolism ‘ The PADIS-PE Trial’ Nate Peyton.
Venous Thromboembolic Disease: The Role of Novel Anticoagulants Grant M. Greenberg MD, MA, MHSA.
Treatment of deep venous thrombosis and pulmonary embolism Anders Waage.
Outpatient DVT assessment & treatment Daniel Gilada.
Women’s Issues and Blood Clotting
Deficiencies of Proteins C, S and Antithrombin and Activated Protein C Resistance – Their Involvement in the Occurrence of Arterial Thromboses Report PGY.
ALIFE2 Study Call for participation
Venous Thromboembolism Prophylaxis for Medical Inpatients
VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy
Dr Ferdous Mehrabian. Dr Ferdous Mehrabian Inherited thrombophilias in pregnancy Inherited thrombophilias is a genetic tendency to venous thrombosis.
Discounted Coagulation Profiles Clinical Laboratories.
Confirmed VTE Treatment Pathway
VTE Prophylaxis South Dakota Perinatal Association Conference
Prevention and Management of Venous Thromboembolic Events in Patients With Multiple Myeloma.
Thrombophilia.
Treatment and secondary prevention strategy diagram for VTE in patients with active cancer based on the treatment guidelines for cancer-associated VTE.
Inherited thrombophilia Screening
Thrombophilia in pregnancy: Whom to screen, when to treat
Prevention and Management of Venous Thromboembolic Events in Patients With Multiple Myeloma.
Presentation transcript:

Management issues in other thrombophilia Ng Heng Joo Department of Haematology Singapore General Hospital

Thrombophilias A disorder of the hemopoietic system in which there is an increased tendency for thrombosis Inherited – Protein C – Protein S – Antithrombin – Factor V Leiden and prothrombin gene mutation Acquired – Malignancy – Antiphospholipid syndrome Natural Anticoagulants

Dear Haematologist, Kindly see this lady who has thrombophilia and advise the role and management of anticoagulation therapy…… Thank you, Your friendly obstetrician

Why was she tested?......whhyyy? Previous venous thromboembolism Screening prompted by family member with similar diagnosis Investigation of recurrent pregnancy losses or subfertility Not sure why

When was testing done? Physiological/pathological situations lowering natural anticoagulant levels – Active thrombosis (AT, PC, PS) – Liver disease (AT, PC, PS) – Heparin therapy (AT) – Nephrotic syndrome (AT, PS) – L-asaparaginase (AT) – DIC (AT, PC, PS) – Pregnancy (PS) – Vitamin K antagonist (PC, PS) – Non-vitamin K oral anticoagulant (variable) – Oral contraceptives (PS) – SLE(PS)

Is it truly low? Protein S levels lower in pre-menopausal women – Lab ranges needs to be determined for younger women Was test repeated and determined to be persistently low? Confirmed! Double confirmed!

Investigation as part of adverse pregnancy outcomes Controversial Modest association suggested with congenital thrombophilia Obstet Gynecol. 2008;

ASH Education Book 2014

Interventional studies Kaandorp SP, Goddijn M, van der Post JA, Hutten BA, Verhoeve HR, Hamulyák K, Mol BW, Folkeringa N, Nahuis M, Papatsonis DN, Büller HR, van der Veen F, Middeldorp S. Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. N Engl J Med Apr 29;362(17): Clark P, Walker ID, Langhorne P, Crichton L, Thomson A, Greaves M, Whyte S, Greer IA; Scottish Pregnancy Intervention Study (SPIN) collaborators. SPIN (Scottish Pregnancy Intervention) study: a multicenter, randomized controlled trial of low- molecular-weight heparin and low-dose aspirin in women with recurrent miscarriage. Blood May 27;115(21): Small subgroups of patients with thrombophilia ALIFE2 – recruiting LMWH vs nothing

Screening for adverse pregnancy outcome? Please don’t, not at the moment ACOG BCSH Guidelines ACCP

When, if ever, should we screen for thrombophilia in the pregnant or soon-to-be pregnant lady? Consider in patients with first degree relative with unprovoked VTE at young age (BCSH, RCOG) Counsel patients on issues related to testing of inherited disorders

Positive thrombophilia, no personal or family history of thrombosis Antepartum – Refer local expert, consider prophylaxis (RCOG) – No prophylaxis (ACCP) Postpartum – 6 weeks prophylaxis (RCOG) – No prophylaxis

Family history, no personal history of thrombosis, positive thrombophilia Antepartum – Refer local expert, consider prophylaxis (RCOG) – No prophylaxis (ACCP) Postpartum – 6 weeks of prophylactic or intermediate dose LMWH

Previous VTE, Anti-thrombin positive Antepartum and post-partum – Intermediate to full dose anticoagulation with LMWH – Post-partum for 6 weeks or until conversion to warfarin

Previous VTE, thrombophilia positive Antepartum and postpartum – Prophylactic or intermediate does LMWH – Continue for at least 6 weeks post-partum

Thank you