Women’s Health Issues in Thrombosis and Haemostasis

August 7, 2005
08:30 to 12:00
Sydney Convention Centre

Chairman:  M. M. Manco-Johnson
Co-chairs: M. Blomback, Sweden, B. Brenner, Israel, J Conard, France, S. Eichinger, Austria, I. Greer, UK, A. James, USA, B, Konkle, USA.

Approximately 150 people attended the SSC meeting on Women’s Issues.

Thrombophilia Issues in Pregnancy

Ian Greer presented a systematic review of thrombophilia in relationship to pregnancy outcomes. He emphasized important variables in screening that the health problem be significant, with a known natural history and identifiable before onset of disease; that the predictive test be safe and acceptable; and finally that an effective intervention be available. It was noted that we are at a time of fragile equipose regarding attitudes toward anticoagulant prophylaxis during high-risk pregnancies, and that women are not willing, in some circumstances to allow randomization to placebo or no treatment. B. Eni Brenner presented his scoring system for severity of thrombophilia syndromes and severity of pregnancy outcomes. The scoring system is intended to predict potential outcome of pregnancy based upon personal and family history of thrombosis, past pregnancy outcome and thrombophilic traits identified. S. Eichinger presented data regarding factor V Leiden and thrombosis outcomes, concentrating on oral contraceptives.

The Scoring System of Dr. Brenner will be compiled to be submitted from this Subcommittee publication in JTH. A collaborative activity will be developed to apply the scoring system prospectively to pregnancy, as an observational study, with or without clinically ordered intervention, in order to validate the scoring system. In particular the strength of a previous history of thrombophilia-related thrombosis in predicting thrombophilia-related non-thrombotic complications of pregnancy needs to be analyzed. S. Eichinger will develop a scoring system for thrombophilia and OCP outcomes modeled on the thrombophilia/pregnancy outcome scoring system. Recommendations regarding issues for women with FVL around oral contraceptive and hormone replacement therapy will be developed. If appropriate, the OCP, HRT and thrombophilia risk scoring system would be later extended beyond FVL to other thrombophilias.

Dr. M. Nijkeuter is continuing to organize the project on diagnosis of pulmonary emboli during pregnancy. This will be reported at the Oslo meeting, next year.

Reports on Registries

Pregnancy Outcomes in Women with Prosthetic Heart Valves : Andra James This registry is developed and three patients have been enrolled. The data base will reside at Duke University, Durham, US. The protocol, consent and data forms will be listed on the ISTH SSC website along with Dr. James contact information.

Thrombotic Outcomes in Women Undergoing Ovarian Stimulation : Barbara Konkle has established this registry on the ISTH SSC website.

Pregnancy Outcomes in Women with Antithrombin Deficiency : J. Conard has developed this registry. It will be expanded to include women with deficiencies of protein C or protein S. Forms, consents and contact information will be included. Dr. Conard can be reached by email: jacqueline.conard@htd.ap-hop-paris.fr

New Business:

Validation of the usefulness of global assays to detect hormonally-related alterations in coagulation. This project is in development. The Women’s Subcommittee will collaborate with the Thrombin Generation Questionnaire that has been developed by the SSc on Plasma Coagulation Inhibitors. All interested potential participants employing global hemostasis assays are encouraged to participate. Contact marilyn.manco-johnson@uchsc.edu.

Position Papers:

Evaluation of Women with Menorrhagia, Claire Phillip, 1st author : This paper has been developed and has been circulated among SSC Subcommittee members. It will be forwarded to the ISTH Council shortly.

Pre-analytic variables affecting testing of hormonally-affected coagulation proteins. Margareta Blomback, 1st author: This paper has been completed and is receiving comments from co-chairs.

Scoring system for thrombophilia and pregnancy outcomes, Benjamin Brenner, 1st author: This paper has been developed and will be circulated among subcommittee members promptly.