Use of selective factor V Leiden screening in pregnancy to identify candidates for anticoagulants.

• OBJECTIVE: To improve identification of gravidas at risk for thrombosis. Venous thromboembolic complications are a major cause of maternal mortality during pregnancy. Factor V Leiden, which causes activated protein C resistance, is the most prevalent thrombophilia in white populations. However, selective screening for factor V Leiden has not been evaluated previously for identifying women who might benefit from anticoagulant prophylaxis during pregnancy. METHODS: We constructed a risk score based on major risk factors such as overweight, family history of thrombosis, previous thrombosis, cesarean delivery, and preeclampsia. A cohort of 2384 women with known factor V Leiden status was studied. Using the risk score and its distribution, we explored possible strategies of doing selective testing for factor V Leiden and their consequences. RESULTS: During the postpartum period, but not antepartum, there is a possibility of identifying women at similar risk as those with a history of thrombosis. Women with a risk score of 2 (4% of women, 0.2% risk of thrombosis) would be screened for factor V Leiden, and those with a resulting risk score of at least 3 (ie, 1.2% risk of thrombosis) would be treated for 6 weeks. Theoretically, for every 83 women treated at this risk level, one thrombotic episode might be prevented. CONCLUSION: By using a risk score, a subgroup of women who could benefit from selective factor V Leiden screening were identified postpartum.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)

Nyckelord

Mass Screening

Predictive Value of Tests

Prenatal Care

Pregnancy

Prenatal Diagnosis : methods

Primary Prevention : methods

Reference Values

Risk Assessment

Thrombosis : prevention & control

Thrombosis : blood

Sweden

Non-U.S. Gov't

Support

Risk Factors

Sensitivity and Specificity

Female

Human

Factor V : analysis

Adult

Anticoagulants : administration & dosage

Biological Markers : blood

Cohort Studies

Comparative Study

Publikations- och innehållstyp

art (ämneskategori)

ref (ämneskategori)