Women’s Issues in Haemostasis and Thrombosis
July 1, 2006
Oslo Kongressenter, Norway
Chair: Marilyn Manco-Johnson
Co-Chairs: M Blömback, Sweden, B Brenner, Israel, J Conard, France, S Eichinger, Austria, I Greer, UK, A James, US, B Konkle US, C Philips, US
Attendance: approximately 80 people attended the meeting
Manuscripts:
Recommendations for testing women for hemostasis: awaiting reviews and approvals
Proposal for a scoring system for thrombophilia and pregnancy outcome in women to be applied to prospective outcome studies
Dr. Brenner will submit his analysis of the scale derivation in 94 Israeli women to JTH as an independent manuscript. The scale will then be placed on the web as a WP project for validation in a multinational study. The strong predictive value of previous thrombosis which is incorporated in this scale was supported by evidence presented by Dr. Conard in women with AT deficiency. The collaborative multicenter study validating the obstetrical scoring system will hopefully be submitted as a recommendation paper from this subcommittee.
Dr. Blomback presented data on correlates of recurrent miscarriage in women. She determined overweight body habitus and obesity predisposing to secondary miscarriage, and certain thrombophilias predisposing to primary miscarriage. The inclusion of recurrent early miscarriage in a scale of maternal risk factors was agreed upon.
Recommendations for evaluation and management of menorrhagia in women.
This manuscript will be reviewed for submission as an SSC publication.
It was discussed that a detailed descriptive study of women with bleeding disorders is currently funded by the US CDC and preliminary data will be presented to this Subcommittee next year. The US data will characterize women with bleeding disorders who are referred to a hemostasis center.
Dr. Shoshana Revel-Vilk will develop a community-based study of adolescents with menorrhagia in order to determine whether predictors for a bleeding disorder can be applied to an adolescent population to increase the yield of coagulation screening. She can be contacted at shoshanav@hadassah.org.il.
Registries:
Pregnancy in women with mechanical heart valves. A James, USA
Dr. James presented a literature review of pregnancy outcome in 76 women with mechanical heart valves as a background to the current registry. Her review is currently in press (J Mat Fetal and Neonatal Med, 2006). The prospective registry is up and running. There have been three case entries and several other centers are in the process of obtaining ethics approvals. It is anticipated that results will be presented to the Geneva SSC meeting.
Pregnancy in women with genetic antithrombin deficiency. J Conard, France
This registry is on the web and now includes 51 women from several centers in France and one other country. Participants were urged to join the registry. An update will be presented in Geneva. Dr. Conard may be contacted at jacqueline.conard@htd.ap-hop-paris.fr
Outcome of ovarian hyperstimulation syndrome. B Konkle, USA.
This registry is near completion and will be on the ISTH website along with sample protocol and ethics consent forms in the near future.
New Business
Diagnosis of Pulmonary embolism in pregnancy: Matilde Nijkeuter, The Netherlands
In this proposal pregnant women with clinically suspected pulmonary emboli will be studied with helical CT and if the study is negative, anticoagulation will be withheld and the woman will be followed for three months in order to determine the safety of the approach. This multicenter study has been initiated in the Netherlands and has enrolled 20 cases. From 100 to 400 cases will be needed to determine the safety of withholding anticoagulation from pregnant women with normal findings on helical CT, based upon an expected rate of positive PE ranging from 5 to 20%. There was some controversy expressed regarding the use of CT in pregnancy and the difficulty to enroll adequate numbers. Nonetheless, the study is endorsed by the subcommittee and potential participants are encouraged to contact Dr. Nijkeuter at Matilde.nijkeuter@lumc.nl.
Proposal for a registry on Mirena IUD in women with menorrhagia: Rezan Kadir, UK
Dr. Kadir presented data regarding use of the Mirena IUD to control menorrhagia in women as a whole, and in subsets of women with confirmed bleeding disorders. While the Mirena IUD has been generally effective and safe, its use in women with bleeding disorders may be accompanied by a higher rate of break-through bleeding and side effects resulting in discontinuation. Response to the registry was positive and it will be posted on the ISTH website. Dr. Kadir may be contacted at rezan.abdul-kadir@royalfree.nhs.uk.
There was a lively discussion provoked by Dr. James presentation on pregnancy in women with mechanical valves relating to the use and requirements for monitoring LMWH during pregnancy. It was decided to form a WP on anti-Xa activity monitoring during pregnancy. Dr. Charlie Hay of the UK, Dr. Aima of Greece and Dr. Sandy Duncan of the US volunteered to organize the WP. They may be contacted at:
haemophilia@man.ac.uk; aima09@hippocratio.gr; and aduncan@emory.edu.
Dr. Manco-Johnson suggested that the current recommendation not to test asymptomatic women prior to use of oral contraceptives or hormonal replacements may be modified if there were a way of improving risk prediction for hormonal-related DVT. Dr. Brenner proposed a study using global assays to predict risk of thrombosis in asymptomatic women presenting for oral contraception or hormone replacement therapy. A lively discussion ensued and it was decided to invite Dr. Rossing and others to speak further on this at the Geneva meeting.
Dr. Manco-Johnson suggested inclusion of neonatal thrombotic disorders including neonatal stroke in the registry of Dr. Brenner to expand detection of potential perinatal risks conferred by thrombophilia or maternal thrombosis. It was decided to embark on this as a joint activity with the Perinatal and Pediatric Subcommittee with Dr. Manco-Johnson acting as a liaison with Dr. Gili Kenet of Israel. Dr. Manco-Johnson can be contacted at marilyn.manco-johnson@uchsc.edu.