HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cleary-Goldman, J. Articles by Schulkin, J. Search for Related Content PubMed PubMed Citation Articles by Cleary-Goldman, J. Articles by Schulkin, J. Related Collections Medical complications of pregnancy

Thrombophilia and the Obstetric Patient

From ¹the Department of Obstetrics and Gynecology, Mount Sinai School of Medicine, New York, New York; ²Department of Research, American College of Obstetricians and Gynecologists, Washington, DC; ³Division of Maternal Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Massachusetts; and ⁴Division of Maternal Fetal Medicine, Yale Medical School, New Haven, Connecticut.

OBJECTIVE: To examine how practicing obstetricians evaluate and manage thrombophilias in selected clinical situations.

METHODS: A questionnaire investigating knowledge and practice patterns pertaining to thrombophilia was mailed to 300 randomly selected American College of Obstetricians and Gynecologists Fellows and Junior Fellows in February 2005.

RESULTS: Approximately 50% (151) of questionnaires were returned. Statistical analysis focused on the 104 responding obstetricians. The majority (greater than 70%) know which thrombophilias are inherited and which are acquired. More than 50% send an inherited thrombophilia panel and antiphospholipid antibodies on patients with a history of fetal demise, intrauterine growth restriction (less than 5th percentile), abruption, and severe preeclampsia. Ninety-two percent test patients with recurrent miscarriages for antiphospholipid antibodies. Despite no clear evidence, 80% also test these patients for inherited thrombophilias. The majority intervene with either thromboprophylaxis or low-dose aspirin when managing patients at risk for thromboembolism. Seventy percent use low-molecular-weight (fractionated) heparin for patients requiring therapeutic anticoagulation, while 62% also use it for prophylactic anticoagulation. Thirty-eight percent of physicians using low-molecular-weight (fractionated) heparin monitor anti-factor Xa levels. The majority (56%) felt their residency training with regard to thrombophilia was barely adequate. Only 8% felt their training was comprehensive, while 36% felt it was adequate.

CONCLUSION: Most responding obstetricians do not manage thrombophilia patients according to expert opinion. Despite the fact that often there is no clear evidence for treatment, many physicians are inclined to intervene in patients at risk for thromboembolism. Educational endeavors are needed to guide obstetricians caring for patients at risk for thromboembolism.

LEVEL OF EVIDENCE: III