Activated protein C resistance (factor V Leiden) associated with thrombosis in pregnancy

OBJECTIVE: Our purpose was to evaluate activated protein C resistance phenotype and genotype among patients with thrombosis during pregnancy and the puerperium. STUDY DESIGN: This observational study was conducted prospectively during a 2-year period (July 1993 to June 1995) in a preselected populat...

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Published in:	American journal of obstetrics and gynecology Vol. 176; no. 4; pp. 889 - 893
Main Authors:	Hallak, Mordechai, Senderowicz, Judith, Cassel, Aliza, Shapira, Chen, Aghai, Ester, Auslender, Ron, Abramovici, Haim
Format:	Journal Article Conference Proceeding
Language:	English
Published:	Philadelphia, PA Mosby, Inc 01-04-1997 Elsevier
Subjects:	Adult Biological and medical sciences Diseases of mother, fetus and pregnancy Factor V - genetics Factor V Leiden Female Gynecology. Andrology. Obstetrics Humans Medical sciences Mutation Pregnancy Pregnancy Complications, Cardiovascular - blood Pregnancy Complications, Cardiovascular - etiology Pregnancy. Fetus. Placenta Prospective Studies Protein C - metabolism Puerperal Disorders - blood Puerperal Disorders - genetics Pulmonary Embolism - blood Pulmonary Embolism - genetics thrombosis Thrombosis - blood Thrombosis - genetics Factor V Leiden thrombosis pregnancy Human Nervous system diseases Stroke Pregnancy disorders Serine endopeptidases Enzyme Cardiovascular disease Thrombosis Cerebral disorder Venous disease Vascular disease Pulmonary embolism Pregnancy Factor V Resistance Peptidases Central nervous system disease Hydrolases Deep vein Mutation Cerebrovascular disease Protein C (activated)
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Summary:	OBJECTIVE: Our purpose was to evaluate activated protein C resistance phenotype and genotype among patients with thrombosis during pregnancy and the puerperium. STUDY DESIGN: This observational study was conducted prospectively during a 2-year period (July 1993 to June 1995) in a preselected population. All patients admitted to our high-risk pregnancy unit with a diagnosis of deep vein thrombosis, pulmonary emboli, transient ischemic attack, and cerebrovascular accident during pregnancy and the puerperium were included. Prothrombin time, partial thromboplastin time, fibrinogen levels, protein C, protein S, antithrombin III, functional test for activated protein C resistance, and factor V Leiden mutation by polymerase chain reaction were performed on each patient. RESULTS: Fifteen patients were included. Seven (46.6%) patients were positive for activated protein C resistance (factor V Leiden). All other coagulation studies were negative for all patients. All patients with activated protein C resistance had a venous thrombotic event, deep vein thrombosis, or pulmonary emboli, and only one had a cerebrovascular accident on the basis of sagittal sinus thrombosis. Only two of the activated protein C resistance–negative patients had venous thrombosis (pulmonary emboli). The remaining six patients had transient ischemic attacks or cerebrovascular accidents. For the subgroup with venous thrombosis during pregnancy and the puerperium, the incidence of activated protein C resistance (factor V Leiden) was 78%. CONCLUSION: This study demonstrates the incidence of factor V Leiden in a selected population in whom thrombotic events developed during pregnancy and the puerperium. This small-scale study provides justification for a large cohort study that will identify women with factor V Leiden and determine their risk for thrombosis during pregnancy and the puerperium. We believe that factor V Leiden should be evaluated in conjunction with thrombotic events in the pregnant woman. (Am J Obstet Gynecol 1997;176:889-93.)
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9378 1097-6868
DOI:	10.1016/S0002-9378(97)70617-3