Management of pregnancy with minor thrombophilia: Thrombophilia testing, anticoagulant prophylaxis. A survey of French practice.

OBJECTIVES

To assess current French practices regarding the prescription of genetic thrombophilia screening and anticoagulant prophylaxis in the antepartum and postpartum periods for pregnancies associated with minor thrombophilia, specifically the heterozygous factor V Leiden (HFVL) mutation.

METHODS

Three clinical cases, presented as questionnaires, were submitted to practitioners involved in the management of pregnancies at risk of thrombosis, with or without thrombophilia.

RESULTS

Three hundred fifty-four questionnaires were analyzed, with a predominance of responses from vascular physicians (n=228). Thrombophilia screening was prescribed in 37% of cases with a second-degree family history of deep vein thrombosis (DVT) but no first-degree family or personal history of DVT, and in 77% of cases with a personal history of DVT. The presence of an HFVL mutation influenced antepartum and postpartum thromboprophylaxis, regardless of the patient's personal or family history of DVT. The timing of thromboprophylaxis initiation and the duration of postpartum treatment also depended on whether this minor thrombophilia was present or absent.

CONCLUSION

This practice survey clearly demonstrates the heterogeneity in the management of pregnant patients with minor thrombophilia. These management approaches are not always consistent with the various national and/or international guidelines. Standardization and improved dissemination of recommendations are necessary.